CMS Price Transparency Data

Trauma team activation

Facility: Mary Hitchcock Memorial Hospital

Billing Code: G0390 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0390
Insurance Median: $2,784
Cash Discount Price: $1,444
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Trauma team activation at Mary Hitchcock Memorial Hospital is $2,784. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,444. Compared to the federal Medicare reimbursement reference rate of $1,361.78, this hospital’s rate is 2.04x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$1,444

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,784

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,361.78

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,361.78 (100%)

Cash / Self-Pay: $1,444 (106%)

Insurance Median: $2,784 (204%)

Cash: $1,444 (106% of Medicare)

Ins. Median: $2,784 (204% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,361.78 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 204% of the Medicare baseline (a markup of 104%). 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	$535	39%
Beacon Health Strategies/Carelon	$576	42%
Wellsense Health Plan	$576 - $1,555	42%
Granite State Health Plan	$594	44%
Blue Cross Blue Shield	$1,481 - $5,761	109%
UnitedHealthcare	$1,481 - $3,623	109%
Martin's Point Health Care	$1,481 - $1,628	109%
Martin's Point Generations Advantage	$1,481	109%
Mvp	$1,510 - $3,161	111%
Aetna	$1,525 - $3,312	112%
Cigna	$1,525 - $3,237	112%
Harvard Pilgrim Health Care of Ne	$1,528 - $3,027	112%
Wellcare Health Plans	$1,540	113%
Ambetter / Centene	$2,042 - $3,186	150%
Tufts Health Plan	$2,658 - $2,752	195%
Mass General Brigham Health Plan	$2,709 - $2,935	199%
Maine Community Health Options	$3,005 - $3,468	221%
First Health/Hcvm	$4,105	301%
Coventry	$4,105	301%
PHCS	$4,246	312%
Corvel	$4,341	319%
Ccmsi	$4,482	329%

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 $1,444.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0390.

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 G0390.
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.