CMS Price Transparency Data

Review of medical records for care

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $171
Cash Discount Price: Unavailable
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Mary Hitchcock Memorial Hospital is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. 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

Unavailable

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 (%)

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	$11 - $12	N/A
Beacon Health Strategies/Carelon	$11	N/A
Granite State Health Plan	$11 - $12	N/A
Wellsense Health Plan	$11 - $69	N/A
Harvard Pilgrim Health Care Of Ne	$50 - $273	N/A
Aetna	$69	N/A
Blue Cross Blue Shield	$69 - $257	N/A
Cigna	$180 - $270	N/A
Mass General Brigham Health Plan	$186	N/A
UnitedHealthcare	$218 - $279	N/A
Martin'S Point Health Care	$321	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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

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 90889.
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.