CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $205
Cash Discount Price: $278
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mary Hitchcock Memorial Hospital is $205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $278. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.15x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$278

Average discount available for prompt cash payment at this facility.

Insurance Median

$205

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $278 (292%)

Insurance Median: $205 (215%)

Cash: $278 (292% of Medicare)

Ins. Median: $205 (215% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 215% of the Medicare baseline (a markup of 115%). 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
Amerihealth Caritas Nh	$38 - $168	40%
Beacon Health Strategies/Carelon	$40 - $181	42%
Wellsense Health Plan	$40 - $181	42%
Granite State Health Plan	$42 - $187	44%
Harvard Pilgrim Health Care Of Ne	$47 - $953	49%
Blue Cross Blue Shield	$64 - $1,295	67%
Martin'S Point Generations Advantage	$64 - $90	67%
Mvp	$64 - $996	67%
UnitedHealthcare	$64 - $1,141	67%
Aetna	$66 - $1,043	69%
Cigna	$66 - $1,019	69%
Martin'S Point Health Care	$66 - $513	69%
Ambetter / Centene	$67 - $296	70%
Wellcare Health Plans	$67 - $94	70%
Tufts Health Plan	$180 - $867	189%
Mass General Brigham Health Plan	$190 - $924	200%
Maine Community Health Options	$211 - $1,092	222%
Coventry	$288 - $1,293	303%
First Health/Hcvm	$288 - $1,293	303%
Phcs	$298 - $1,337	313%
Corvel	$305 - $1,367	320%
Ccmsi	$314 - $1,412	330%

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 $278.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.