CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: St Mary's Healthcare

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $143
Cash Discount Price: $99
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at St Mary's Healthcare is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.79x the Medicare baseline. Located in 427 Guy Park Avenue, Amsterdam, NY.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $99 (55%)

Insurance Median: $143 (79%)

Cash: $99 (55% of Medicare)

Ins. Median: $143 (79% 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
Excellus_Commercial	$69 - $236	38%
Aetna	$70 - $239	39%
Emblem_Commercial	$70 - $239	39%
Carelon_Empire	$82 - $383	45%
Carelon_Commercial	$85 - $398	47%
Humana	$93 - $233	51%
Medicare (plans)	$93 - $248	51%
Va	$93 - $222	51%
Blue Cross Blue Shield	$138 - $228	76%
Cdphp_Commercial	$162	89%
Medicaid / KanCare	$167 - $187	92%
UnitedHealthcare	$167	92%
Tricare	$222	122%

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 $99.
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 St Mary's Healthcare 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.