CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: Clay County Hospital

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90837
Insurance Median: $277
Cash Discount Price: $437
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at Clay County Hospital is $277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $437. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.53x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$437

Average discount available for prompt cash payment at this facility.

Insurance Median

$277

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: $437 (241%)

Insurance Median: $277 (153%)

Cash: $437 (241% of Medicare)

Ins. Median: $277 (153% 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
Aetna	$118 - $345	65%
Ambetter / Centene	$118	65%
Medica(Wellfirst)	$118 - $271	65%
Meridian	$118	65%
UnitedHealthcare	$118 - $350	65%
Wellcare	$118	65%
Blue Cross Blue Shield	$226 - $321	125%
Healthlink	$284 - $350	157%
Cigna	$350	193%
Usa Mco	$415	229%

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 $437.
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 Clay County 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.