CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: Pinckneyville Community Hospital

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90837
Insurance Median: $356
Cash Discount Price: $445
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at Pinckneyville Community Hospital is $356. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $445. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.96x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$445

Average discount available for prompt cash payment at this facility.

Insurance Median

$356

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: $445 (245%)

Insurance Median: $356 (196%)

Cash: $445 (245% of Medicare)

Ins. Median: $356 (196% 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
Humana	$159 - $170	88%
Umwa Mcr Adv - All Plans	$159 - $170	88%
UnitedHealthcare	$159 - $376	88%
Wellcare Mcr Adv - All Plans	$159 - $170	88%
Aetna	$163 - $844	90%
Blue Cross Blue Shield	$310 - $844	171%
Healthlink Hmo	$338 - $360	186%
Phcs - All Other Plans	$353 - $376	195%
Cigna	$356 - $379	196%
Healthlink Ppo - All Other Plans	$356 - $379	196%
Healthlink Work Comp	$356 - $379	196%
Phcs Savility	$366 - $390	202%
Multiplan - All Plans	$388 - $413	214%
Ambetter / Centene	$844	465%
Medicaid / KanCare	$844	465%

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 $445.
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 Pinckneyville Community 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.