CMS Price Transparency Data

Extended office visit (prolonged)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: G2212 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G2212
Insurance Median: $95
Cash Discount Price: $77
vs. Medicare Baseline: 2.79x Medicare

The contracted insurance negotiated median rate for a Extended office visit (prolonged) at Mary Hitchcock Memorial Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $34.07, this hospital’s rate is 2.79x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $77 (226%)

Insurance Median: $95 (279%)

Cash: $77 (226% of Medicare)

Ins. Median: $95 (279% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 279% of the Medicare baseline (a markup of 179%). 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
Harvard Pilgrim Health Care of Ne	$22 - $162	65%
Amerihealth Caritas Nh	$29 - $35	85%
Mvp	$30 - $169	88%
UnitedHealthcare	$30 - $194	88%
Martin's Point Generations Advantage	$30 - $31	88%
Blue Cross Blue Shield	$30 - $220	88%
Cigna	$31 - $173	91%
Martin's Point Health Care	$31 - $87	91%
Ambetter / Centene	$31 - $103	91%
Beacon Health Strategies/Carelon	$31 - $34	91%
Wellsense Health Plan	$31 - $35	91%
Wellcare Health Plans	$31 - $33	91%
Aetna	$31 - $177	91%
Granite State Health Plan	$32 - $36	94%
Mass General Brigham Health Plan	$85 - $157	249%
Tufts Health Plan	$99 - $147	291%
Maine Community Health Options	$161 - $185	473%
Coventry	$219	643%
First Health/Hcvm	$219	643%
PHCS	$227	666%
Corvel	$232	681%
Ccmsi	$239	701%

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 $77.
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 Mary Hitchcock 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.