Psychotherapy session (45 minutes)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 90834 (CPT)
- CPT Billing Code: 90834
- Insurance Median: $515
- Cash Discount Price: $642
- vs. Medicare Baseline: 2.84x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 284% of the Medicare baseline (a markup of 184%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $137 | 76% |
| Humana | $370 | 204% |
| Tricare | $399 | 220% |
| Aetna | $468 - $680 | 258% |
| Medicaid / KanCare | $468 - $755 | 258% |
| UnitedHealthcare | $468 - $755 | 258% |
| Ambetter / Centene | $515 | 284% |
| Health Partners - All Plans | $717 | 395% |
| Healthy Blue Mcaid - All Plans | $755 | 416% |
Consumer Guidance & Cost Commentary
For this psychotherapy session at Trego County Lemke Memorial Hospital, the cash price of $642.00 is notably lower than the negotiated rates charged by most major payers, ranging from $468.00 to $755.00. While the facility's cash rate is higher than the state of Kansas average for this service, it remains significantly below the gross chargemaster price of $755.00. Patients with high-deductible plans or those without insurance may find the cash price more affordable than their insurance allowed amounts, which can exceed $500 depending on the plan. It is important to note that while commercial rates are often inflated by administrative overhead, the cash price here reflects a direct fee that bypasses these additional costs.
To minimize potential balance billing or unexpected charges, patients should verify their specific plan's allowed amount before scheduling, as some insurers may allow more than the cash price. If a patient chooses to pay out-of-network or self-pay, they should explicitly request a "self-pay" or "prompt-pay" discount at registration, as hospitals often offer additional reductions for upfront payment. Furthermore, if a bill is received, patients should demand a full itemized audit rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By comparing the final allowed amount to the Medicare benchmark of $181.34, patients can better understand the markup and negotiate a fair settlement if necessary.