CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: St Marys Hospital Superior

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $149
Cash Discount Price: $256
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at St Marys Hospital Superior is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.82x the Medicare baseline. Located in 3500 Tower Ave, Superior, WI.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

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: $256 (141%)

Insurance Median: $149 (82%)

Cash: $256 (141% of Medicare)

Ins. Median: $149 (82% 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
Advocare/Security Health	$111	61%
Blue Cross Blue Shield	$111 - $279	61%
Freedom Blue Ppo	$111	61%
Healthpartners Care Msho / Mcr Adv	$111	61%
Imcare Msho Pcc Prime	$111	61%
Imcare Msho Ref Req	$111	61%
Medica Advantage Solutions	$111	61%
Medica Msho/Dual Solutions	$111	61%
Medica Prime Solution Group	$111	61%
Medica Uplan	$111	61%
Medicare (plans)	$111	61%
Nd Va Administration	$111	61%
Platinum Blue/Vantage Blue	$111	61%
Primewest Msho	$111	61%
Secure Blue Msho	$111	61%
Ubh Cost Plan	$111	61%
Ubh Msho	$111	61%
Ucare Msho	$111	61%
UnitedHealthcare	$111 - $314	61%
Blue Plus Pmap Pcc Prime	$133	73%
Healthpartners Care Pmap	$139	77%
Medica Access	$139	77%
Sanford Healthplan	$149	82%
Primewest	$154	85%
Itasca Med Care	$161	89%
Ucare	$228	126%
Healthpartners	$235 - $271	130%
Medica	$244 - $271	135%
Wea	$250 - $267	138%
Security Health	$267	147%
America'S Ppo	$269	148%
Cigna	$271	149%
Healthpartners Pcc Prime	$271	149%
Medica Choice	$279	154%
Wps	$291	160%
Aetna	$295	163%
Healtheos	$298	164%

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 $256.
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 St Marys Hospital Superior 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.