CMS Price Transparency Data

Behavioral health assessment

Facility: Mary Hitchcock Memorial Hospital

Billing Code: H0001 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: H0001
Insurance Median: $295
Cash Discount Price: $178
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Behavioral health assessment at Mary Hitchcock Memorial Hospital is $295. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$295

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$2 - $408	N/A
Cigna	$24 - $399	N/A
Harvard Pilgrim Health Care of Ne	$29 - $373	N/A
Amerihealth Caritas Nh	$66 - $218	N/A
Wellsense Health Plan	$71 - $218	N/A
Beacon Health Strategies/Carelon	$71 - $212	N/A
Granite State Health Plan	$73 - $224	N/A
Blue Cross Blue Shield	$157 - $506	N/A
Martin's Point Health Care	$200	N/A
UnitedHealthcare	$285 - $446	N/A
Tufts Health Plan	$327 - $339	N/A
Mass General Brigham Health Plan	$334 - $361	N/A
Maine Community Health Options	$370 - $427	N/A
Mvp	$389	N/A
First Health/Hcvm	$505	N/A
Coventry	$505	N/A
PHCS	$523	N/A
Corvel	$535	N/A
Ccmsi	$552	N/A

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 $178.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: H0001.

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 H0001.
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.