CMS Price Transparency Data

Behavioral health day program

Facility: Mary Hitchcock Memorial Hospital

Billing Code: H2012 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: H2012
Insurance Median: $29
Cash Discount Price: Unavailable
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Behavioral health day program at Mary Hitchcock Memorial Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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 (%)

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Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Cigna	$22	N/A
Wellsense Health Plan	$25	N/A
Aetna	$25 - $60	N/A
Blue Cross Blue Shield	$25	N/A
Harvard Pilgrim Health Care of Ne	$29	N/A
Mass General Brigham Health Plan	$203 - $268	N/A
Martin's Point Health Care	$229	N/A

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: H2012.

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 H2012.
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.