CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Kenmore Mercy Hospital

Billing Code: 90791 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$184

about 1.0× the $181 Medicare rate · typically $142–$195

modeled estimate · not a bill or quote

What this hospital charges insurers

$167

About the fair price

about $17 under the fair price · 0.9× Medicare

Medicare pays $181 Fair price $184 This hospital $167 Cash price $315 Hospital's list price $315

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $143 Priciest $167

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Psychiatric evaluation (first visit) is about $184 (about 1.0× the $181 Medicare rate). Kenmore Mercy Hospital charges insurers about $167, or about $315 in cash — about the fair price. Located in Kenmore, NY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$102 - $146	56%
Blue Cross Blue Shieldmajor	$69 - $186	38%
Aetnamajor	$153	84%
Cignamajor	$146 - $211	81%
Humanamajor	$153	84%
Amerigroup	$108	60%
Fidelis Care	$153 - $175	84%
Independent Health	$108 - $167	60%
Molina	$242	133%
MVP Health Care	$110 - $156	61%
UPMC Health Plan	$262	144%
WellCare	$153 - $160	84%
+ 16 smaller / regional plans	$108 - $230

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 315), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 90791.

Insurance Before you use insurance

Call your insurance company to confirm Kenmore Mercy Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 90791.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Kenmore Mercy Hospital

Compare: Psychiatric evaluation (first visit) at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.