CMS Price Transparency Data

Vaginal delivery (full package)

Facility: Kenmore Mercy Hospital

Billing Code: 59400 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 59400
Insurance Median: $2,295
Cash Discount Price: $4,666
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Vaginal delivery (full package) at Kenmore Mercy Hospital is $2,295. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,666. Compared to the federal Medicare reimbursement reference rate of $2,214.42, this hospital’s rate is 1.04x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$4,666

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,295

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2,214.42

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2,214.42 (100%)

Cash / Self-Pay: $4,666 (211%)

Insurance Median: $2,295 (104%)

Cash: $4,666 (211% of Medicare)

Ins. Median: $2,295 (104% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2,214.42 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
Federal Workers Compensation [500100]	$1,707	77%
No Fault [114001]	$1,707	77%
Vna Option Mltc [350110]	$1,738	78%
Amerigroup [350102]	$1,738	78%
Independent Health Essential [100166]	$1,738	78%
Excellus Rochester McD [350117]	$1,738	78%
Medicaid / KanCare	$1,738 - $2,295	78%
Tuscarora Nation [550120]	$1,738	78%
Crime Victims [100176]	$1,738	78%
Blue Cross Blue Shield	$1,738 - $2,390	78%
Univera Healthcare [100169]	$1,962 - $2,609	89%
Univera Healthcare Essential [100170]	$1,962	89%
VA Veterans Affairs [700001]	$2,066	93%
Beacon Essential [350122]	$2,066 - $2,754	93%
UnitedHealthcare	$2,066 - $2,297	93%
Medicare (plans)	$2,141 - $2,525	97%
Cigna	$2,295 - $3,328	104%
Catholic Health Life Pace [400005]	$2,295	104%
Tricare	$2,295	104%
Seneca Nation [450119]	$2,295	104%
Hospice [550001]	$2,295	104%
Covid19 Hrsa [45013]	$2,295	104%
Fallon Health [450115]	$2,295	104%
Champ VA [700002]	$2,295	104%
Humana	$2,410	109%
Fidelis Dual Advantage [450120]	$2,410	109%
Wellcare Fidelis Dual [450451]	$2,410	109%
Aetna	$2,410	109%
Iha First Choice [800001]	$2,497	113%
Independent Health [100165]	$2,497	113%
Fidelis Essential [100163]	$2,525	114%
Ghi [100153]	$2,525	114%
Wellcare [450129]	$2,525	114%
Mvp Healthcare [100168]	$2,596	117%
Beacon Health Options [100023]	$2,754	124%
Fidelis Exchange [100164]	$2,754	124%
Molina Essential [100167]	$3,910	177%
UPMC Health Plan [100181]	$4,131	187%

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 $4,666.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 59400.

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 59400.
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.