CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Kaleida Health

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $234
Cash Discount Price: $538
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Kaleida Health is $234. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $538. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.29x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$538

Average discount available for prompt cash payment at this facility.

Insurance Median

$234

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: $538 (297%)

Insurance Median: $234 (129%)

Cash: $538 (297% of Medicare)

Ins. Median: $234 (129% 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
Independent Health Association	$115 - $361	63%
Independent Health Association - Wchob	$120 - $361	66%
Univera	$129 - $309	71%
Univera - Wchob	$129 - $300	71%
Blue Cross Blue Shield	$151 - $827	83%
Ghi/Emblem Health	$170 - $299	94%
Ghi/Emblem Health - Wchob	$170 - $212	94%
Aetna	$177 - $235	98%
Magnacare	$177 - $262	98%
Magnacare - Wchob	$177 - $262	98%
Tricare	$210	116%
Wellcare	$230	127%
Fidelis	$239	132%
UnitedHealthcare	$240	132%
Cigna	$259 - $315	143%

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 $538.
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 Kaleida Health 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.