CMS Price Transparency Data

Psychotherapy session (45 minutes)

Facility: Kenmore Mercy Hospital

Billing Code: 90834 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90834
Insurance Median: $89
Cash Discount Price: $287
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Psychotherapy session (45 minutes) at Kenmore Mercy Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $287. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.49x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$287

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $287 (158%)

Insurance Median: $89 (49%)

Cash: $287 (158% of Medicare)

Ins. Median: $89 (49% 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.

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	$36 - $104	20%
UnitedHealthcare	$62 - $92	34%
Medicaid / KanCare	$67 - $89	37%
Excellus Rochester McD [350117]	$71	39%
Tuscarora Nation [550120]	$71	39%
Independent Health Essential [100166]	$71	39%
Amerigroup [350102]	$71	39%
Vna Option Mltc [350110]	$71	39%
Crime Victims [100176]	$71	39%
Mvp Healthcare [100168]	$73 - $104	40%
Univera Healthcare Essential [100170]	$74	41%
Univera Healthcare [100169]	$74 - $109	41%
Beacon Essential [350122]	$80 - $107	44%
VA Veterans Affairs [700001]	$80	44%
Medicare (plans)	$86 - $101	47%
Cigna	$89 - $129	49%
Fallon Health [450115]	$89	49%
Hospice [550001]	$89	49%
Seneca Nation [450119]	$89	49%
Catholic Health Life Pace [400005]	$89	49%
Tricare	$89	49%
Covid19 Hrsa [45013]	$89	49%
Champ VA [700002]	$89	49%
Wellcare Fidelis Dual [450451]	$94	52%
Aetna	$94	52%
Humana	$94	52%
Fidelis Dual Advantage [450120]	$94	52%
Ghi [100153]	$98	54%
Fidelis Essential [100163]	$98	54%
Wellcare [450129]	$98	54%
Independent Health [100165]	$102	56%
Iha First Choice [800001]	$102	56%
Beacon Health Options [100023]	$107	59%
Fidelis Exchange [100164]	$107	59%
Federal Workers Compensation [500100]	$150	83%
No Fault [114001]	$150	83%
Molina Essential [100167]	$160	88%
UPMC Health Plan [100181]	$160	88%

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 $287.
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 Kenmore Mercy Hospital 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.