CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $461
Cash Discount Price: $996
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Mary Hitchcock Memorial Hospital is $461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $996. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.89x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$996

Average discount available for prompt cash payment at this facility.

Insurance Median

$461

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $996 (409%)

Insurance Median: $461 (189%)

Cash: $996 (409% of Medicare)

Ins. Median: $461 (189% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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.

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
Wellsense Health Plan	$54 - $622	22%
Blue Cross Blue Shield	$68 - $4,441	28%
Martin'S Point Generations Advantage	$68 - $270	28%
Mvp	$68 - $3,414	28%
UnitedHealthcare	$68 - $3,914	28%
Aetna	$70 - $3,577	29%
Cigna	$70 - $3,496	29%
Martin'S Point Health Care	$70 - $1,758	29%
Ambetter / Centene	$71 - $582	29%
Wellcare Health Plans	$71 - $281	29%
Harvard Pilgrim Health Care Of Ne	$85 - $3,269	35%
Beacon Health Strategies/Carelon	$89 - $622	37%
Amerihealth Caritas Nh	$92 - $577	38%
Granite State Health Plan	$92 - $642	38%
Mass General Brigham Health Plan	$198 - $3,170	81%
Tufts Health Plan	$227 - $2,973	93%
Maine Community Health Options	$900 - $3,746	369%
Coventry	$1,229 - $4,434	504%
First Health/Hcvm	$1,229 - $4,434	504%
Phcs	$1,272 - $4,586	522%
Corvel	$1,300 - $4,688	533%
Ccmsi	$1,342 - $4,841	551%

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 $996.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

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 CPT code 72148.
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.