CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Community Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $171
Cash Discount Price: $134
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Community Memorial Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.94x the Medicare baseline. Located in W180 N8085 Town Hall Rd, Menomonee Falls, WI.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $134 (74%)

Insurance Median: $171 (94%)

Cash: $134 (74% of Medicare)

Ins. Median: $171 (94% 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
Centivo	$73 - $81	40%
UnitedHealthcare	$81 - $466	45%
Froedtert South	$102	56%
Chorus Community Health Plan	$105	58%
Network Health Plan	$134 - $156	74%
Common Ground	$146	81%
Sheboygan Employers Health Network	$151	83%
Allwell	$156	86%
Blue Cross Blue Shield	$156 - $207	86%
Community Care	$156	86%
Health Partners	$156 - $159	86%
Humana	$156	86%
Icare	$156	86%
Security Health Plan	$156	86%
Aetna	$159 - $171	88%
Care Wisconsin/Mychoice	$161	89%
Trilogy	$168	93%
Health Payment Systems	$170	94%
Wisconsin Physician Services	$171	94%
Aspirus	$195	108%
Ibsi Passport	$198	109%
Americas Choice	$212	117%
Compsych	$212	117%
Federated Mutual	$212	117%
Healtheos	$212	117%
Multiplan/Private Healthcare Systems	$212	117%
Savility	$212	117%
Cigna	$215	119%
First Health Network	$215	119%
Healthsmart	$220	121%
Physicians Plus	$220	121%

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 $134.
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 Community Memorial Hospital 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.