CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Crouse Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $222
Cash Discount Price: $373
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Crouse Hospital is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $373. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.22x the Medicare baseline. Located in 736 Irving Avenue, Syracuse, NY.

Cash / Self-Pay

$373

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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: $373 (206%)

Insurance Median: $222 (122%)

Cash: $373 (206% of Medicare)

Ins. Median: $222 (122% 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
Brighton Healthplan	$167 - $222	92%
Excellus	$167 - $398	92%
Fidelis	$167 - $376	92%
Healthfirst Health Plan	$167 - $184	92%
Molina	$167 - $376	92%
UnitedHealthcare	$167 - $222	92%
Wellcare	$167 - $233	92%
Mycompass	$172 - $228	95%
Aetna	$222	122%
Cdphp	$222	122%
Emblemhealth	$222	122%
Humana	$222	122%
Martins Point	$222	122%
Mvp	$222 - $465	122%
Nascentia	$222	122%
Emblem Health	$499	275%

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 $373.
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 Crouse 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.