CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: Piedmont Macon North Hospital

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90837
Insurance Median: $340
Cash Discount Price: $155
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at Piedmont Macon North Hospital is $340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.87x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$340

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: $155 (85%)

Insurance Median: $340 (187%)

Cash: $155 (85% of Medicare)

Ins. Median: $340 (187% 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	$47 - $83	26%
UnitedHealthcare	$216 - $332	119%
Phcs [10601]	$309	170%
Industry Buying Group [10840]	$335	185%
Aetna	$340 - $376	187%
Cigna	$350	193%
First Health [10303]	$360	199%
Novanet [10819]	$386	213%
Beechstreet [10800]	$412	227%
Multiplan [10600]	$464	256%

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 $155.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90837.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Piedmont Macon North Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90837.
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.