CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Sarasota Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $173
Cash Discount Price: $162
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Sarasota Memorial Hospital is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.95x the Medicare baseline. Located in 1700 S Tamiami Trl, Sarasota, FL.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $162 (89%)

Insurance Median: $173 (95%)

Cash: $162 (89% of Medicare)

Ins. Median: $173 (95% 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
Simply Healthcare Oncology	$118 - $138	65%
Sunshine State Oncology	$118 - $138	65%
Molina Oncology	$122 - $142	67%
Amerihealth Caritas Oncology	$124 - $145	68%
Community Care Plan Oncology	$124 - $145	68%
Blue Cross Blue Shield	$140 - $279	77%
UnitedHealthcare	$145 - $305	80%
Aetna	$147 - $325	81%
Florida Community Care Oncology	$149 - $211	82%
Simply Healthcare	$157 - $165	87%
Wellcare Oncology	$157 - $181	87%
Simply Freedom Optimum Oncology	$163 - $187	90%
Sunshine State	$165	91%
Simply Freedom Optimum	$169	93%
Wellcare	$169	93%
Molina	$170	94%
Amerihealth Caritas	$173	95%
Community Care Plan	$173	95%
Florida Community Care	$173 - $177	95%
Careworks	$270	149%
Enlyte	$270	149%
Oscar Oncology	$288	159%
Avmed	$296	163%
Usa Managed Care	$325	179%
First Health	$337	186%
Ambetter / Centene	$393 - $455	217%

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 $162.
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 Sarasota 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.