CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Albany Medical Center Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $164
Cash Discount Price: $121
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Albany Medical Center Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.90x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $121 (67%)

Insurance Median: $164 (90%)

Cash: $121 (67% of Medicare)

Ins. Median: $164 (90% 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
Medicaid / KanCare	$51 - $152	28%
UnitedHealthcare	$52 - $478	29%
Emblem	$56 - $478	31%
Emblem_Ghi	$56 - $478	31%
Empire Plan Nyship	$56 - $172	31%
Magnacare	$56 - $478	31%
Multiplan	$60 - $508	33%
Blue Shield	$70 - $319	39%
Cdphp	$96 - $529	53%
Carelon Beacon Behavioral	$102 - $185	56%
Blue Cross Blue Shield	$106 - $529	58%
Medicare (plans)	$106 - $178	58%
Tricare	$106 - $164	58%
Fidelis	$111 - $529	61%
Mvp	$113 - $242	62%
Hamaspik	$117 - $553	65%
Blue Shield Highmark	$120 - $287	66%
Aetna	$126 - $344	69%
Cigna	$136 - $242	75%
Nascentia	$155 - $180	85%
Emblem Health Ghi	$157 - $356	87%
Nascentia Health Options	$221	122%
Nys Department Of Corrections	$278 - $305	153%
Mvp Commercial	$284 - $373	157%
Mvp Essential Plan	$506	279%

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 $121.
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 Albany Medical Center 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.