CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Strong Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $228
Cash Discount Price: $326
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Strong Memorial Hospital is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $326. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.26x the Medicare baseline. Located in 601 Elmwood Ave, Rochester, NY.

Cash / Self-Pay

$326

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $326 (180%)

Insurance Median: $228 (126%)

Cash: $326 (180% of Medicare)

Ins. Median: $228 (126% 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%
Blue Cross Blue Shield	$63 - $419	35%
Excellus [2201]	$63	35%
UnitedHealthcare	$91 - $419	50%
Aetna	$120 - $456	66%
Excellus Bc/Bs [2201]	$120 - $307	66%
Medicare (plans)	$120 - $246	66%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$128 - $570	71%
Molina Healthcare [5189]	$137	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%
United Behavioral Health [131701]	$162	89%
United Behavioral Health [5185]	$162	89%
Fidelis [5155]	$171 - $419	94%
Mvp [2900]	$175 - $809	97%
Independent Health [5156]	$195 - $243	108%
Cigna	$340 - $809	187%
Capital District Physicians Health Plan (Cdphp) [5149]	$376 - $580	207%
Molina Healthcare [1723], Molina Healthcare [5189]	$419	231%

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 $326.
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 Strong 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.