CMS Price Transparency Data

Psychotherapy session (45 minutes)

Facility: Mc Donough District Hospital

Billing Code: 90834 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90834
Insurance Median: $265
Cash Discount Price: $191
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (45 minutes) at Mc Donough District Hospital is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.46x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

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: $191 (105%)

Insurance Median: $265 (146%)

Cash: $191 (105% of Medicare)

Ins. Median: $265 (146% 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
Health Alliance	$54 - $287	30%
Aetna	$75 - $322	41%
Hfn	$79 - $290	44%
UnitedHealthcare	$79 - $290	44%
Humana	$91 - $290	50%
Medicaid / KanCare	$91 - $322	50%
Medicare (plans)	$91 - $179	50%
Meridian	$91 - $179	50%
Molina	$91 - $322	50%
Mutual Medical	$91 - $322	50%
Veteran Affairs	$91 - $179	50%
Tricare	$167	92%
Blue Cross Blue Shield	$194 - $322	107%
Springfield Health	$257 - $264	142%
Consociate	$266 - $274	147%
Trilogy	$266 - $274	147%
Blue Choice	$282 - $290	156%
Current Health	$282 - $290	156%
Healthlink	$282 - $303	156%
Preferred Plan	$297 - $306	164%

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 $191.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90834.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mc Donough District Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90834.
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.