CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Community Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $499
Cash Discount Price: $178
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Community Medical Center is $499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.75x the Medicare baseline. Located in 99 Rt 37 West, Toms River, NJ.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$499

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: $178 (98%)

Insurance Median: $499 (275%)

Cash: $178 (98% of Medicare)

Ins. Median: $499 (275% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 275% of the Medicare baseline (a markup of 175%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Fidelis Care	$108 - $176	60%
Aetna	$117 - $472	65%
Blue Cross Blue Shield	$176 - $785	97%
Clover Health	$176	97%
Humana	$176	97%
Wellpoint	$176 - $489	97%
Emblem Health	$307	169%
Wellcare	$349	192%
Cigna	$510 - $682	281%
First Health	$515	284%
Qualcare Inc	$572 - $610	315%
Amerihealth	$639	352%

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 $178.
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 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.