CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Highland Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $232
Cash Discount Price: $442
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Highland Hospital is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $442. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.28x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$442

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $442 (244%)

Insurance Median: $232 (128%)

Cash: $442 (244% of Medicare)

Ins. Median: $232 (128% 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	$44 - $419	24%
Amerigroup (Bswny Alternate) [1720]	$54 - $419	30%
Excellus [2201]	$54	30%
UnitedHealthcare	$54 - $419	30%
Aetna	$120 - $456	66%
Excellus Bc/Bs [2201]	$120 - $307	66%
Medicare (plans)	$120 - $263	66%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$128 - $570	71%
Molina Healthcare [5189], Molina Healthcare [1723]	$137 - $419	76%
Elderplan [1316]	$141 - $164	78%
Icircle [1728]	$141 - $164	78%
Martins Point [1205]	$141 - $222	78%
Nascentia [1729]	$141 - $164	78%
Humana	$143 - $243	79%
Highmark Bc/Bs Of Western Ny [5143]	$150 - $176	83%
Fidelis [5155]	$171 - $419	94%
Independent Health [5156]	$195 - $243	108%
Mvp [2900]	$198 - $809	109%
Blue Cross Blue Shield	$222 - $316	122%
Cigna	$340 - $809	187%
Capital District Physicians Health Plan (Cdphp) [5149]	$376 - $580	207%

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 $442.
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 Highland 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.