CMS Price Transparency Data

Injection procedure for pain management

Facility: Ira Davenport Memorial Hospital

Billing Code: G0260 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0260
Insurance Median: $1,743
Cash Discount Price: $1,936
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Injection procedure for pain management at Ira Davenport Memorial Hospital is $1,743. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,936. Compared to the federal Medicare reimbursement reference rate of $721.17, this hospital’s rate is 2.42x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$1,936

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,743

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$721.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $721.17 (100%)

Cash / Self-Pay: $1,936 (268%)

Insurance Median: $1,743 (242%)

Cash: $1,936 (268% of Medicare)

Ins. Median: $1,743 (242% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $721.17 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 242% of the Medicare baseline (a markup of 142%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$527 - $11,696	73%
Fidelis	$757	105%
Tricare	$820	114%
Humana	$820 - $3,470	114%
Amerihealth Caritas McR Adv - All Plans	$828	115%
Fidelis Care - Exchange - All Plans	$1,065 - $2,120	148%
Geisinger - All Plans	$1,127 - $2,243	156%
Cigna	$1,206 - $2,402	167%
Mvp Health Plan - All Plans	$1,206 - $2,402	167%
Independent Health - All Plans	$1,259 - $2,506	175%
UPMC - All Plans	$1,336 - $2,660	185%
Pomco Inc - All Plans	$1,394 - $2,776	193%
UnitedHealthcare	$1,452 - $2,891	201%
Aetna	$1,452 - $2,891	201%
Emblem Health - All Plans	$1,704 - $3,393	236%
Emblem/Ghi	$1,789	248%
Martins Point - All Plans	$1,936 - $3,855	268%
Healthnow - All Plans	$6,378 - $12,698	884%

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 $1,936.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0260.

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 G0260.
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.