CMS Price Transparency Data

X-ray, lower back

Facility: Alice Peck Day Memorial Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $546
Cash Discount Price: $384
vs. Medicare Baseline: 5.11x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Alice Peck Day Memorial Hospital is $546. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $384. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.11x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$384

Average discount available for prompt cash payment at this facility.

Insurance Median

$546

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: $384 (360%)

Insurance Median: $546 (511%)

Cash: $384 (360% of Medicare)

Ins. Median: $546 (511% 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 511% of the Medicare baseline (a markup of 411%). 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
Ambetter / Centene	$10	9%
Nh Healthy Families	$10	9%
Blue Cross Blue Shield	$308 - $635	288%
Wellpoint	$308	288%
Medicaid / KanCare	$327	306%
Harvard Pilgrim	$443 - $618	415%
UnitedHealthcare	$513	480%
Tufts	$523	490%
Cigna	$546 - $583	511%
Commercial Generic	$546	511%
Connecticut General	$546	511%
Klais	$551	516%
Aetna	$642	601%
Mvp	$649	608%
Coventry Health	$677	634%
Coventry Health Wc	$677	634%
Humana	$742	695%

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 $384.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Alice Peck Day Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72110.
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.