Psychotherapy session (60 minutes)
Facility: Hiawatha Community Hospital
Billing Code: 90837 (CPT)
- CPT Billing Code: 90837
- Insurance Median: $327
- Cash Discount Price: $420
- vs. Medicare Baseline: 1.80x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $144 - $151 | 79% |
| Aetna | $155 - $339 | 85% |
| UnitedHealthcare | $155 - $361 | 85% |
| Humana | $157 | 87% |
| Ambetter / Centene | $186 | 103% |
| Oscar - All Plans | $315 | 174% |
| Centrus Health Direct - All Plans | $315 | 174% |
| Preferred Hlth - All Plans | $378 | 208% |
| Cigna | $399 | 220% |
| Wppa Providrs Care - All Plans | $399 | 220% |
| Midlands Choice - All Plans | $407 | 224% |
| Multiplan - All Plans | $407 | 224% |
| Healthy Blue Mcaid - All Plans | $420 | 232% |
Consumer Guidance & Cost Commentary
For this psychotherapy session at Hiawatha Community Hospital, the cash price is $420, which matches the facility's gross chargemaster rate. While the hospital's negotiated rates with major insurers like Aetna and UnitedHealthcare range from $155 to $399, these amounts are generally higher than the cash price. This is a common scenario where paying out-of-pocket can be more cost-effective for patients with high-deductible plans, as the insurance negotiated rate often exceeds the cash price. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final cost.
The facility's pricing is benchmarked against the Medicare rate of $181.34, which serves as the objective baseline for evaluating hospital markups. The cash price of $420 represents a significant markup compared to this federal standard, reflecting the administrative costs and profit margins inherent in commercial billing. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still review their itemized bills carefully to ensure no unbundled codes or services not rendered have been charged. If discrepancies are found, a formal written audit dispute sent to the billing supervisor is the most effective way to resolve errors and reduce medical debt.