CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Marshfield Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $206
Cash Discount Price: $219
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Marshfield Medical Center is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $219. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.14x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$219

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$181.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $181.34 (100%)

Cash / Self-Pay: $219 (121%)

Insurance Median: $206 (114%)

Cash: $219 (121% of Medicare)

Ins. Median: $206 (114% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $181.34 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Family Health Center (Fhc)	$116	64%
Security Health Plan (Shp)	$117 - $172	65%
Amish/Mennonite	$127	70%
Sanford Health Plan	$127	70%
Veteran'S Administration (Va Ccn)	$153	84%
Blue Cross Blue Shield	$157 - $203	87%
The Alliance	$161 - $193	89%
Group Health Cooperative Of Eau Claire	$162 - $213	89%
Besse Forest Products	$196	108%
Molina Healthcare Of Wi	$196	108%
Rice Lake School District	$196	108%
Wps Health Insurance	$204 - $223	112%
Trilogy	$208 - $222	115%
UnitedHealthcare	$210	116%
Medica Of Wi	$214 - $219	118%
Cigna	$217	120%
Healtheos By Multiplan Inc.	$217 - $219	120%
Corvel	$219	121%
First Health	$219	121%
Health Partners	$219	121%
Three Rivers Provider Network (Trpn)	$219	121%
Coventry	$222	122%
Health Smart	$222	122%
Rising Medical Work Comp	$224	124%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $219.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90791.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Marshfield Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90791.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.