CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 71250 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$408

about 3.8× the $107 Medicare rate · typically $118–$953

modeled estimate · not a bill or quote

What this hospital charges insurers

$362

Below the fair price — a good deal

about $46 under the fair price · 3.4× Medicare

Medicare pays $107 Fair price $408 This hospital $362 Cash price $762 Hospital's list price $1,413

How we calculate the fair BaseRate →

How this hospital compares to other NH hospitals

On the higher side — 6 of 8 other NH hospitals charge less.

Cheapest $85 Priciest $421

Black dot = this hospital, among the 9 NH hospitals with a price for this procedure. Full list below.

A fair price for a CT scan, chest (no contrast) is about $408 (about 3.8× the $107 Medicare rate). Alice Peck Day Memorial Hospital charges insurers about $362, or about $762 in cash — below the fair price — a good deal. Located in Lebanon, NH.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$1,017	952%
Blue Cross Blue Shieldmajor	$688 - $1,258	644%
Aetnamajor	$1,272 - $1,342	1191%
Cignamajor	$784 - $1,156	734%
Humanamajor	$1,470	1376%
Ambetter (Centene)	$36	34%
Harvard Pilgrim	$879 - $1,225	823%
MVP Health Care	$1,286	1204%
Tufts Health Plan	$1,036	970%
+ 4 smaller / regional plans	$37 - $832

Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 762), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 71250.

Insurance Before you use insurance

Call your insurance company to confirm Alice Peck Day Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 71250.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Alice Peck Day Memorial Hospital

Compare: CT scan, chest (no contrast) at other NH hospitals

Insurance negotiated median for the same procedure, sorted lowest first.