CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Saratoga Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $150
Cash Discount Price: $229
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Saratoga Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $229. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.83x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$229

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: $229 (126%)

Insurance Median: $150 (83%)

Cash: $229 (126% 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
Mvp Commercial	$49 - $343	27%
Medicaid / KanCare	$51 - $152	28%
Multiplan	$52 - $388	29%
Empire Plan Nyship	$60 - $216	33%
UnitedHealthcare	$60 - $411	33%
Magnacare	$63 - $434	35%
Blue Shield	$70 - $457	39%
Fidelis	$78 - $535	43%
Blue Cross Blue Shield	$80 - $440	44%
Cdphp	$96 - $535	53%
Medicare (plans)	$106 - $164	58%
Tricare	$106 - $164	58%
Mvp	$113 - $242	62%
Hamaspik	$117 - $559	65%
Aetna	$126 - $189	69%
Cigna	$136 - $242	75%
Emblem Health Ghi	$141 - $180	78%
Blue Shield Highmark	$142 - $188	78%
Emblem	$190 - $228	105%
Nascentia Health Options	$221	122%
Mvp Essential Plan	$238 - $476	131%
Mvp Govt Programs	$238	131%

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 $229.
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 Saratoga 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.