CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: Adena Pike Medical Center

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90837
Insurance Median: $424
Cash Discount Price: $281
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at Adena Pike Medical Center is $424. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.34x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$424

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: $281 (155%)

Insurance Median: $424 (234%)

Cash: $281 (155% of Medicare)

Ins. Median: $424 (234% 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 234% of the Medicare baseline (a markup of 134%). 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
Aetna	$135 - $458	74%
Blue Cross Blue Shield	$135 - $485	74%
Buckeye Community Health Plan	$135	74%
Humana	$135 - $534	74%
Medical Mutual Of Ohio	$135 - $357	74%
Medigold	$135	74%
Molina	$135	74%
Care Source	$138	76%
Gateway Health	$186	103%
Molina Marketplace	$221	122%
Care Source Just4Me	$243	134%
Sidecar Health	$371	205%
Ohio Ppo Connect	$394	217%
The Health Plan	$394	217%
Cigna	$407	224%
Medical Mutual Of Ohio Supermed	$424	234%
First Health	$441	243%
Ohio Health Choice	$448	247%
UnitedHealthcare	$484	267%
Integrated Health Plan	$529	292%
Healthsmart	$534	294%
Multiplan/Private Healthcare Systems	$534	294%
Three Rivers Network	$534	294%

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 $281.
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 Adena Pike Medical Center 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.