CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: St Anthony Community Hospital

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90837
  • Insurance Median: $364
  • Cash Discount Price: $579
  • vs. Medicare Baseline: 2.01x Medicare
The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at St Anthony Community Hospital is $364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $579. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.01x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.
Cash / Self-Pay
$579

Average discount available for prompt cash payment at this facility.

Insurance Median
$364

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: $579 (319%)
Insurance Median: $364 (201%)
Cash: $579 (319% of Medicare)
Ins. Median: $364 (201% 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 201% of the Medicare baseline (a markup of 101%). 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.

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
Mvp Gold (McR) $131 72%
Mvp Exchange $144 79%
Mvp Hmo/Ppo $169 93%
Self-Pay - Cc 30% $174 96%
Medicare (plans) $220 - $236 121%
Hamaspik (McR) $220 121%
Tricare $222 122%
Affinity By Molina McR $232 128%
Cdphp $290 160%
Self-Pay - Cc 50% $290 160%
Aetna $342 - $376 189%
Blue Cross Blue Shield $352 - $434 194%
Emblem Select Care (Exchange) $394 217%
Oxford Exchange $405 223%
UnitedHealthcare $406 - $478 224%
PHCS $434 239%
Multiplan $434 239%
Emblem Ghi/Hip PPO $463 255%
Emblem Ghi/Hip Hmo/Epo/Pos $463 255%
Magnacare Preferred $521 287%
Oxford Commercial $546 301%
First Health $579 319%
Geisinger Health Commercial/Exchange $728 401%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15 Maple Avenue -19, Warwick, NY 10990
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals