CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Gundersen Lutheran Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $159
Cash Discount Price: $90
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Gundersen Lutheran Medical Center is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.88x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $90 (50%)

Insurance Median: $159 (88%)

Cash: $90 (50% of Medicare)

Ins. Median: $159 (88% 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
Blue Cross Blue Shield	$66 - $318	36%
Medica	$80 - $183	44%
Ucare	$96 - $191	53%
Dean Health Plan	$100	55%
Quartz	$101	56%
Amerigroup	$103 - $159	57%
Group Health Eau Claire	$103 - $215	57%
Group Health Of South Central	$103 - $191	57%
Icare	$103 - $159	57%
Iowa Total Care	$103	57%
Managed Health Service	$103	57%
Molina Health	$103 - $153	57%
UnitedHealthcare	$103 - $195	57%
Aetna	$105 - $227	58%
Health Partners	$120 - $211	66%
Medical Associates	$159 - $179	88%
Midland Choice	$179	99%
Alliance	$188 - $201	104%
Claim Doc Llc	$191	105%
Wps Narrow Network	$194	107%
Cigna	$196	108%
Wps - Arise	$196	108%
Aspirus Arise Health	$198	109%
Allied National General	$203	112%
Preferred One	$203	112%
Wps Statewide	$203	112%
Coventry Health Care	$227	125%
Humana	$227	125%
Multiplan/Healtheos	$229	126%

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 $90.
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 Gundersen Lutheran 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.