CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $248
  • Cash Discount Price: $295
  • vs. Medicare Baseline: 2.32x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Mary Hitchcock Memorial Hospital is $248. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $295. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.32x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.
Cash / Self-Pay
$295

Average discount available for prompt cash payment at this facility.

Insurance Median
$248

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $295 (276%)
Insurance Median: $248 (232%)
Cash: $295 (276% of Medicare)
Ins. Median: $248 (232% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 232% of the Medicare baseline (a markup of 132%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Amerihealth Caritas Nh $14 - $313 13%
Beacon Health Strategies/Carelon $14 - $337 13%
Granite State Health Plan $14 - $347 13%
Wellsense Health Plan $34 - $337 32%
Blue Cross Blue Shield $49 - $2,792 46%
Martin'S Point Generations Advantage $49 - $119 46%
Mvp $49 - $1,849 46%
UnitedHealthcare $49 - $2,119 46%
Aetna $51 - $1,937 48%
Cigna $51 - $1,893 48%
Martin'S Point Health Care $51 - $952 48%
Wellcare Health Plans $51 - $124 48%
Ambetter / Centene $52 - $256 49%
Harvard Pilgrim Health Care Of Ne $62 - $1,770 58%
Mass General Brigham Health Plan $154 - $1,716 144%
Tufts Health Plan $157 - $1,610 147%
Maine Community Health Options $178 - $2,028 167%
Coventry $243 - $2,400 228%
First Health/Hcvm $243 - $2,400 228%
Phcs $251 - $2,483 235%
Corvel $257 - $2,538 241%
Ccmsi $265 - $2,621 248%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Medical Center Drive, Lebanon, NH 03756
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals