CMS Price Transparency Data

Extended office visit (prolonged)

Facility: Ira Davenport Memorial Hospital

Billing Code: G2212 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G2212
Insurance Median: $36
Cash Discount Price: $17
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Extended office visit (prolonged) at Ira Davenport Memorial Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17. Compared to the federal Medicare reimbursement reference rate of $34.07, this hospital’s rate is 1.06x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$17

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $17 (50%)

Insurance Median: $36 (106%)

Cash: $17 (50% of Medicare)

Ins. Median: $36 (106% 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
Empire	$21 - $25	62%
Fidelis	$36	106%
Blue Cross Blue Shield	$36	106%
Aetna	$72	211%
Emblem/Ghi	$75	220%
UnitedHealthcare	$85	249%

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 $17.
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 Ira Davenport Memorial 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.