CMS Price Transparency Data

Hospital observation (per hour)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: G0378 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0378
Insurance Median: $171
Cash Discount Price: $97
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hospital observation (per hour) at Mary Hitchcock Memorial Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. 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

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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
Amerihealth Caritas Nh	$16 - $51	N/A
Wellsense Health Plan	$18 - $55	N/A
Granite State Health Plan	$18 - $57	N/A
Beacon Health Strategies/Carelon	$18 - $55	N/A
Aetna	$41 - $1,361	N/A
Blue Cross Blue Shield	$41 - $391	N/A
Harvard Pilgrim Health Care of Ne	$47 - $288	N/A
Cigna	$56 - $308	N/A
UnitedHealthcare	$71 - $639	N/A
Tufts Health Plan	$82 - $253	N/A
Mass General Brigham Health Plan	$83 - $258	N/A
Maine Community Health Options	$92 - $330	N/A
Mvp	$97 - $301	N/A
Coventry	$126 - $391	N/A
First Health/Hcvm	$126 - $391	N/A
PHCS	$130 - $404	N/A
Corvel	$133 - $413	N/A
Ccmsi	$138 - $427	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 $97.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0378.

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 G0378.
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.