CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Nicholas H Noyes Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $153
Cash Discount Price: $180
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Nicholas H Noyes Memorial Hospital is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $180. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.84x the Medicare baseline. Located in 111 Clara Barton Street, Dansville, NY.

Cash / Self-Pay

$180

Average discount available for prompt cash payment at this facility.

Insurance Median

$153

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: $180 (99%)

Insurance Median: $153 (84%)

Cash: $180 (99% of Medicare)

Ins. Median: $153 (84% 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 - $182	24%
Blue Cross Blue Shield	$55 - $386	30%
UnitedHealthcare	$86 - $436	47%
Mvp 2900	$109 - $497	60%
Medicare (plans)	$110 - $239	61%
Aetna	$124 - $236	68%
Excellus 2201	$124 - $169	68%
Cigna	$151 - $334	83%
Independent Health 5156	$186 - $254	103%
Fidelis 5155	$197 - $228	109%
Humana	$222	122%
Empire Plan 5179	$356	196%
Capital District Physicians Health Plan (Cdphp) 5149	$376 - $433	207%
Pomco Ins Co 5157	$472	260%

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 $180.
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 Nicholas H Noyes Memorial 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.