CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Sisters of Charity Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $156
Cash Discount Price: $315
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Sisters of Charity Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $315. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.86x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$315

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $315 (174%)

Insurance Median: $156 (86%)

Cash: $315 (174% of Medicare)

Ins. Median: $156 (86% 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
Blue Cross Blue Shield	$69 - $186	38%
UnitedHealthcare	$102 - $146	56%
Amerigroup [350102]	$108	60%
Excellus Rochester McD [350117]	$108	60%
Independent Health Essential [100166]	$108	60%
Tuscarora Nation [550120]	$108	60%
Medicaid / KanCare	$108 - $146	60%
Crime Victims [100176]	$108	60%
Vna Option Mltc [350110]	$108	60%
Mvp Healthcare [100168]	$110 - $156	61%
Univera Healthcare Essential [100170]	$127	70%
Univera Healthcare [100169]	$127 - $186	70%
Medicare (plans)	$129 - $169	71%
Beacon Essential [350122]	$131 - $175	72%
VA Veterans Affairs [700001]	$131	72%
Seneca Nation [450119]	$146	81%
Tricare	$146	81%
Fallon Health [450115]	$146	81%
Catholic Health Life Pace [400005]	$146	81%
Champ VA [700002]	$146	81%
Cigna	$146 - $211	81%
Hospice [550001]	$146	81%
Covid19 Hrsa [45013]	$146	81%
Aetna	$153	84%
Wellcare Fidelis Dual [450451]	$153	84%
Fidelis Dual Advantage [450120]	$153	84%
Humana	$153	84%
Ghi [100153]	$160	88%
Wellcare [450129]	$160	88%
Fidelis Essential [100163]	$160	88%
Independent Health [100165]	$167	92%
Iha First Choice [800001]	$167	92%
Fidelis Exchange [100164]	$175	97%
Beacon Health Options [100023]	$175	97%
No Fault [114001]	$230	127%
Federal Workers Compensation [500100]	$230	127%
Workers Compensation [500101]	$230	127%
Molina Essential [100167]	$242	133%
UPMC Health Plan [100181]	$262	144%

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 $315.
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 Sisters of Charity 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.