CMS Price Transparency Data

Psychotherapy session (45 minutes)

Facility: Sanford Hillsboro

Billing Code: 90834 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90834
Insurance Median: $623
Cash Discount Price: $604
vs. Medicare Baseline: 3.44x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (45 minutes) at Sanford Hillsboro is $623. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $604. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 3.44x the Medicare baseline. Located in 12 Third Street Se, Hillsboro, ND.

Cash / Self-Pay

$604

Average discount available for prompt cash payment at this facility.

Insurance Median

$623

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: $604 (333%)

Insurance Median: $623 (344%)

Cash: $604 (333% of Medicare)

Ins. Median: $623 (344% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 344% of the Medicare baseline (a markup of 244%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$183 - $699	101%
Sanford Health Plan Align	$344	190%
Ucare	$370 - $663	204%
Aetna	$373 - $656	206%
Health Partners	$373 - $589	206%
Medicare (plans)	$373	206%
UnitedHealthcare	$373 - $630	206%
Primewest	$381	210%
Security Health Plan	$415	229%
Sanford Health Plan	$596 - $701	329%
Medica	$623 - $666	344%
First Choice Health Network	$680	375%
Healthez	$680	375%
Multiplan	$680	375%

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 $604.
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 Sanford Hillsboro 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.