CMS Price Transparency Data

Extended office visit (prolonged)

Facility: Kenmore Mercy Hospital

Billing Code: G2212 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G2212
Insurance Median: $32
Cash Discount Price: $63
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Extended office visit (prolonged) at Kenmore Mercy Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $34.07, this hospital’s rate is 0.94x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$34.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $34.07 (100%)

Cash / Self-Pay: $63 (185%)

Insurance Median: $32 (94%)

Cash: $63 (185% of Medicare)

Ins. Median: $32 (94% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $34.07 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
UnitedHealthcare	$23 - $36	68%
Medicaid / KanCare	$24 - $30	70%
Univera Healthcare [100169]	$25 - $34	73%
Univera Healthcare Essential [100170]	$25	73%
Blue Cross Blue Shield	$26 - $37	76%
Beacon Essential [350122]	$27 - $36	79%
Medicare (plans)	$28 - $33	82%
Hospice [550001]	$30	88%
Champ VA [700002]	$30	88%
Cigna	$30 - $44	88%
Covid19 Hrsa [45013]	$30	88%
Catholic Health Life Pace [400005]	$30	88%
Tricare	$30	88%
Fallon Health [450115]	$30	88%
VA Veterans Affairs [700001]	$30	88%
Seneca Nation [450119]	$30	88%
Iha First Choice [800001]	$32	94%
Independent Health [100165]	$32	94%
Wellcare Fidelis Dual [450451]	$32	94%
Aetna	$32	94%
Humana	$32	94%
Fidelis Dual Advantage [450120]	$32	94%
Ghi [100153]	$33	97%
Fidelis Essential [100163]	$33	97%
Wellcare [450129]	$33	97%
Fidelis Exchange [100164]	$36	106%
Beacon Health Options [100023]	$36	106%
UPMC Health Plan [100181]	$54	158%

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 $63.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G2212.

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 G2212.
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.