CMS Price Transparency Data

X-ray, pelvis

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $67
  • Cash Discount Price: $122
  • vs. Medicare Baseline: 0.63x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Mary Hitchcock Memorial Hospital is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 0.63x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.
Cash / Self-Pay
$122

Average discount available for prompt cash payment at this facility.

Insurance Median
$67

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $122 (114%)
Insurance Median: $67 (63%)
Cash: $122 (114% of Medicare)
Ins. Median: $67 (63% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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.

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 $5 - $125 5%
Aetna $8 - $442 7%
Blue Cross Blue Shield $8 - $549 7%
Cigna $8 - $432 7%
Martin'S Point Generations Advantage $8 - $119 7%
Martin'S Point Health Care $8 - $217 7%
Mvp $8 - $422 7%
UnitedHealthcare $8 - $585 7%
Wellcare Health Plans $8 - $124 7%
Ambetter / Centene $9 - $256 8%
Harvard Pilgrim Health Care Of Ne $10 - $777 9%
Amerihealth Caritas Nh $16 - $100 15%
Beacon Health Strategies/Carelon $16 - $97 15%
Granite State Health Plan $16 - $103 15%
Mass General Brigham Health Plan $23 - $392 22%
Tufts Health Plan $27 - $368 25%
Maine Community Health Options $106 - $463 99%
Coventry $144 - $548 135%
First Health/Hcvm $144 - $548 135%
Phcs $149 - $567 140%
Corvel $153 - $580 143%
Ccmsi $158 - $598 148%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Medical Center Drive, Lebanon, NH 03756
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals