CMS Price Transparency Data

CT scan, pelvis

Facility: Alice Peck Day Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $1,203
  • Cash Discount Price: $937
  • vs. Medicare Baseline: 11.26x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Alice Peck Day Memorial Hospital is $1,203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $937. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.26x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.
Cash / Self-Pay
$937

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,203

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: $937 (877%)
Insurance Median: $1,203 (1126%)
Cash: $937 (877% of Medicare)
Ins. Median: $1,203 (1126% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1126% of the Medicare baseline (a markup of 1026%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Ambetter / Centene $43 40%
Nh Healthy Families $44 41%
Blue Cross Blue Shield $688 - $1,547 644%
Wellpoint $688 644%
Cigna $784 - $1,422 734%
Klais $784 734%
Medicaid / KanCare $798 747%
Commercial Generic $832 779%
Connecticut General $832 779%
Harvard Pilgrim $1,081 - $1,507 1012%
UnitedHealthcare $1,251 1171%
Tufts $1,274 1193%
Aetna $1,564 1464%
Mvp $1,582 1481%
Coventry Health $1,651 1546%
Coventry Health Wc $1,651 1546%
Humana $1,808 1693%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 10 Alice Peck Day Drive, Lebanon, NH 03766
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals