CMS Price Transparency Data

Flu vaccine (high dose)

Facility: Kenmore Mercy Hospital

Billing Code: 90656 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90656
Insurance Median: $22
Cash Discount Price: $26
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Flu vaccine (high dose) at Kenmore Mercy Hospital is $22. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$26

Average discount available for prompt cash payment at this facility.

Insurance Median

$22

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Univera Healthcare [100169]	$10 - $12	N/A
Medicare (plans)	$11 - $23	N/A
No Fault [114001]	$14	N/A
Federal Workers Compensation [500100]	$14	N/A
Iha First Choice [800001]	$20	N/A
Independent Health Essential [100166]	$20	N/A
Independent Health [100165]	$20	N/A
Medicaid / KanCare	$20	N/A
Humana	$20	N/A
Ghi [100153]	$22	N/A
Hospice [550001]	$22	N/A
Cigna	$22	N/A
Fallon Health [450115]	$22	N/A
Seneca Nation [450119]	$22	N/A
Covid19 Hrsa [45013]	$22	N/A
Wellcare Fidelis Dual [450451]	$23	N/A
VA Veterans Affairs [700001]	$23	N/A
UnitedHealthcare	$23 - $33	N/A
Blue Cross Blue Shield	$23 - $38	N/A
Fidelis Dual Advantage [450120]	$23	N/A
Wellcare [450129]	$25	N/A

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 $26.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: 90656.

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 HCPCS code 90656.
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.