CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Maimonides Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $150
Cash Discount Price: $503
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Maimonides Medical Center is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $503. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.83x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$503

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $503 (277%)

Insurance Median: $150 (83%)

Cash: $503 (277% of Medicare)

Ins. Median: $150 (83% 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
Healthfirst	$42 - $217	23%
United Community Plan	$56 - $244	31%
UnitedHealthcare	$56 - $140	31%
Carelon Behavioral Health	$64 - $233	35%
Metroplus	$97 - $266	53%
Blue Cross Blue Shield	$115 - $496	63%
Elderplan	$126 - $157	69%
Fidelis	$129 - $149	71%
Healthfirst Early Start	$141	78%
Aetna	$146 - $268	81%
Oxford Health Plan	$162	89%
Local 1199	$165	91%
Molina	$186	103%
Villagecare Maxx Fida	$191	105%
Magnacare	$242	133%
Centivo	$345	190%
Emblem Health - Ghi	$674	372%

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 $503.
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 Maimonides Medical Center 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.