Psychiatric evaluation (first visit)
Facility: Wamego Health Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $141
- Cash Discount Price: $145
- vs. Medicare Baseline: 0.78x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $110 | 61% |
| UnitedHealthcare | $136 | 75% |
| Aetna | $141 | 78% |
| Medicaid / KanCare | $141 - $143 | 78% |
| Providrs Care | $218 | 120% |
| Blue Cross Blue Shield | $222 - $234 | 122% |
Consumer Guidance & Cost Commentary
For CPT code 90791, a psychiatric evaluation at the Wamego Health Center in Wamego, Kansas, the facility's cash median rate is $145.00, which is lower than the negotiated rates paid by most major payers. While the facility's cash price is significantly below the gross charge of $363.00, patients with high-deductible plans may find paying out-of-pocket cheaper than relying on insurance, as the negotiated rates for insurers like UnitedHealthcare ($136), Aetna ($141), and Medicaid/KanCare ($141–$143) often exceed the cash price. To maximize savings, patients should explicitly ask the billing department for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs and higher negotiated ceilings associated with insurance claims.
When evaluating this cost, it is important to compare rates against the Medicare benchmark rather than the facility's inflated chargemaster list. The Medicare amount for this service is $181.34, which serves as a scientifically validated baseline for the true cost of care; commercial negotiated rates typically average 200% to 300% of this figure, whereas fair pricing is generally defined as 120% to 150%. Although the data does not provide specific state or county average comparisons for this code, patients should be aware that balance billing remains a risk if they receive care from out-of-network providers, where the provider could bill the difference between their full rate and the insurance allowed amount. To avoid unexpected costs, consumers should request a full itemized bill to verify that no unb