Mary Hitchcock Memorial Hospital
Mary Hitchcock Memorial Hospital in Lebanon, NH publishes cash prices for 70 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
One Medical Center Dr, Lebanon, NH 03756 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD AND PELVIS CONTRAST | $1,964.83 | $6,421.00 | 69% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABD AND PELVIS CONTRAST | $1,964.83 | $6,421.00 | 69% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT SCAN HEAD/BRAIN | $867.51 | $2,835.00 | 69% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT SCAN HEAD/BRAIN | $867.51 | $2,835.00 | 69% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT SCAN PELVIS CONTRAST | $1,112.62 | $3,636.00 | 69% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT SCAN PELVIS CONTRAST | $1,112.62 | $3,636.00 | 69% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $335.38 | $1,096.00 | 69% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI | $335.38 | $1,096.00 | 69% |
| Diagnostic mammogram, one breast CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $261.32 | $854.00 | 69% |
| Diagnostic mammogram, one breast inpatient CPT 77065 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI | $261.32 | $854.00 | 69% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOWER EXTREMITY JOINT | $1,585.39 | $5,181.00 | 69% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MRI LOWER EXTREMITY JOINT | $1,585.39 | $5,181.00 | 69% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI LOWER EXTREMITY JOINT W/O&W CONTRAST | $2,283.98 | $7,464.00 | 69% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI LOWER EXTREMITY JOINT W/O&W CONTRAST | $2,283.98 | $7,464.00 | 69% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN | $1,720.33 | $5,622.00 | 69% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN | $1,720.33 | $5,622.00 | 69% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W/O&W CONTRAST | $2,294.69 | $7,499.00 | 69% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W/O&W CONTRAST | $2,294.69 | $7,499.00 | 69% |
| MRI of the lower back, no contrast dye CPT 72148 MRI LUMBAR SPINE | $1,559.38 | $5,096.00 | 69% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI LUMBAR SPINE | $1,559.38 | $5,096.00 | 69% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREGNANT UTERUS AFTER 1ST TRIMEST 1ST GESTATION | $429.32 | $1,403.00 | 69% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREGNANT UTERUS AFTER 1ST TRIMEST 1ST GESTATION | $429.32 | $1,403.00 | 69% |
| Screening mammogram, both breasts both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $293.45 | $959.00 | 69% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD | $293.45 | $959.00 | 69% |
| Transvaginal pelvic ultrasound CPT 76830 OVULATION INDUCTION US TRANSVAGINAL | $143.82 | $470.00 | 69% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL | $362.30 | $1,184.00 | 69% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 OVULATION INDUCTION US TRANSVAGINAL | $143.82 | $470.00 | 69% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL | $362.30 | $1,184.00 | 69% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOM B-SCAN &/OR REAL TIME, COMPLETE | $504.59 | $1,649.00 | 69% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOM B-SCAN &/OR REAL TIME, COMPLETE | $504.59 | $1,649.00 | 69% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY LUMBAR SPINE MINIMUM 4/5 VW | $320.38 | $1,047.00 | 69% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-RAY LUMBAR SPINE MINIMUM 4/5 VW | $320.38 | $1,047.00 | 69% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL WITH TOTAL CALCIUM | $27.85 | $91.00 | 69% |
| Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL WITH TOTAL CALCIUM | $27.85 | $91.00 | 69% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 POCT LIPID PANEL | $47.12 | $154.00 | 69% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $47.12 | $154.00 | 69% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 POCT LIPID PANEL | $47.12 | $154.00 | 69% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $47.12 | $154.00 | 69% |
| Complete blood count (CBC) with differential CPT 85025 BLOOD COUNT - HEMO | $16.22 | $53.00 | 69% |
| Complete blood count (CBC) with differential CPT 85025 CBC,PLT & AUTO DIFF | $26.62 | $87.00 | 69% |
| Complete blood count (CBC) with differential inpatient CPT 85025 BLOOD COUNT - HEMO | $16.22 | $53.00 | 69% |
| Complete blood count (CBC) with differential inpatient CPT 85025 CBC,PLT & AUTO DIFF | $26.62 | $87.00 | 69% |
| Complete blood count (CBC), no differential CPT 85027 HEMOGRAM | $16.52 | $54.00 | 69% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HEMOGRAM | $16.52 | $54.00 | 69% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PNL '00 | $49.27 | $161.00 | 69% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PNL '00 | $49.27 | $161.00 | 69% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $34.88 | $114.00 | 69% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $34.88 | $114.00 | 69% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PNL '00 | $25.70 | $84.00 | 69% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PNL '00 | $25.70 | $84.00 | 69% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PCH PSA FREE | $23.87 | $78.00 | 69% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 FREE PSA | $64.26 | $210.00 | 69% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PCH PSA FREE | $23.87 | $78.00 | 69% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 FREE PSA | $64.26 | $210.00 | 69% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PCH TOTAL PSA (PHI) | $17.14 | $56.00 | 69% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC AG SCREENING | $38.86 | $127.00 | 69% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN | $38.86 | $127.00 | 69% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PCH TOTAL PSA (PHI) | $17.14 | $56.00 | 69% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC AG SCREENING | $38.86 | $127.00 | 69% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN | $38.86 | $127.00 | 69% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PCH PTT (CGP) | $19.58 | $64.00 | 69% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 PARTIAL THROMBOPLASTIN TIME | $20.81 | $68.00 | 69% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PCH PTT (CGP) | $19.58 | $64.00 | 69% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PARTIAL THROMBOPLASTIN TIME | $20.81 | $68.00 | 69% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $21.11 | $69.00 | 69% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME | $21.11 | $69.00 | 69% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 PCH TSH; NEOGEN | $16.83 | $55.00 | 69% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE, SERUM | $30.91 | $101.00 | 69% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 PCH TSH; NEOGEN | $16.83 | $55.00 | 69% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE, SERUM | $30.91 | $101.00 | 69% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS ROUTINE | $50.18 | $164.00 | 69% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS ROUTINE | $50.18 | $164.00 | 69% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO, W/O SCOPE | $35.19 | $115.00 | 69% |
| Urinalysis without microscope exam, automated CPT 81003 UA W/OUT MICROSCOPIC | $37.03 | $121.00 | 69% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, AUTO, W/O SCOPE | $35.19 | $115.00 | 69% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 UA W/OUT MICROSCOPIC | $37.03 | $121.00 | 69% |
| Urinalysis without microscope exam, manual CPT 81002 POCT URINALYSIS NONAUTO W/O SCOPE | $18.36 | $60.00 | 69% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS, DIP STICK OR TABLET, NON-AUTO W/O MICROSCOPY | $18.36 | $60.00 | 69% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 POCT URINALYSIS NONAUTO W/O SCOPE | $18.36 | $60.00 | 69% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS, DIP STICK OR TABLET, NON-AUTO W/O MICROSCOPY | $18.36 | $60.00 | 69% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 EXTRACAPSULAR CATARACT RMVL INSERTION IO LENS PROSTH W/O ECP | $3,447.09 | $11,265.00 | 69% |
| Cataract surgery with lens implant inpatient CPT 66984 EXTRACAPSULAR CATARACT RMVL INSERTION IO LENS PROSTH W/O ECP | $3,447.09 | $11,265.00 | 69% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM | $4,523.29 | $14,782.00 | 69% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM | $4,794.71 | $15,669.00 | 69% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM | $4,523.29 | $14,782.00 | 69% |
| Cesarean delivery, including prenatal and postpartum care inpatient CPT 59510 OB ANTEPARTUM CARE CESAREAN DELIVERY & POSTPARTUM | $4,794.71 | $15,669.00 | 69% |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,184.83 | $3,872.00 | 69% |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,184.83 | $3,872.00 | 69% |
| Colonoscopy with endoscopic ultrasound inpatient CPT 45391 COLONOSCOPY EXAM OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ | $1,844.26 | $6,027.00 | 69% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY FLEXIBLE W RMVL OF TUMOR POLYP LESION SNARE TQ | $1,844.26 | $6,027.00 | 69% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W BIOPSY SINGLE/MULTIPLE | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W BIOPSY SINGLE/MULTIPLE | $1,623.64 | $5,306.00 | 69% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W BIOPSY SINGLE/MULTIPLE | $1,322.23 | $4,321.00 | 69% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W BIOPSY SINGLE/MULTIPLE | $1,623.64 | $5,306.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE DX W COLLECTION SPECIMEN WHEN PFRMD | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY ON PT AT HIGH RISK | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY PT NOT AT HIGH RISK | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEXIBLE DX W COLLECTION SPECIMEN WHEN PFRMD | $1,279.39 | $4,181.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY ON PT AT HIGH RISK | $1,279.39 | $4,181.00 | 69% |
| Colonoscopy, diagnostic CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY PT NOT AT HIGH RISK | $1,279.39 | $4,181.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE DX W COLLECTION SPECIMEN WHEN PFRMD | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY ON PT AT HIGH RISK | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY PT NOT AT HIGH RISK | $1,016.53 | $3,322.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEXIBLE DX W COLLECTION SPECIMEN WHEN PFRMD | $1,279.39 | $4,181.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY ON PT AT HIGH RISK | $1,279.39 | $4,181.00 | 69% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLORECTAL CANCER SCREENING, COLONOSCOPY PT NOT AT HIGH RISK | $1,279.39 | $4,181.00 | 69% |
| Gallbladder removal, laparoscopic CPT 47562 LAP, CHOLECYSTECTOMY | $3,481.67 | $11,378.00 | 69% |
| Gallbladder removal, laparoscopic inpatient CPT 47562 LAP, CHOLECYSTECTOMY | $3,481.67 | $11,378.00 | 69% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR 1ST INGUINAL HERNIA AGE 5 YRS OR OLDER REDUCIBLE | $2,074.99 | $6,781.00 | 69% |
| Inguinal (groin) hernia repair, age 5 or older inpatient CPT 49505 REPAIR 1ST INGUINAL HERNIA AGE 5 YRS OR OLDER REDUCIBLE | $2,074.99 | $6,781.00 | 69% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY, KNEE, W MENISCECTOMY, MEDIAL OR LATERAL, W SHAVING | $3,883.75 | $12,692.00 | 69% |
| Knee arthroscopy with meniscus trim inpatient CPT 29881 ARTHROSCOPY, KNEE, W MENISCECTOMY, MEDIAL OR LATERAL, W SHAVING | $3,883.75 | $12,692.00 | 69% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY | $959.31 | $3,135.00 | 69% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 POST-CATARACT LASER SURGERY | $2,252.47 | $7,361.00 | 69% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST-CATARACT LASER SURGERY | $959.31 | $3,135.00 | 69% |
| Laser treatment of clouding after cataract surgery (YAG) inpatient CPT 66821 POST-CATARACT LASER SURGERY | $2,252.47 | $7,361.00 | 69% |
| Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH W INJ LEFT VENTRICULOGRAPHY IMG S&I | $6,894.79 | $22,532.00 | 69% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH W INJ LEFT VENTRICULOGRAPHY IMG S&I | $6,894.79 | $22,532.00 | 69% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN | $956.25 | $3,125.00 | 69% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN | $959.00 | $3,134.00 | 69% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN | $956.25 | $3,125.00 | 69% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DX/THER SBST INTRLMNR LMBR/SAC W IMG GDN | $959.00 | $3,134.00 | 69% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ DX/THER SBST INTERLAMINAR LMBR/SAC WO IMG GDN | $829.57 | $2,711.00 | 69% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ DX/THER SBST INTERLAMINAR LMBR/SAC WO IMG GDN | $891.38 | $2,913.00 | 69% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DX/THER SBST INTERLAMINAR LMBR/SAC WO IMG GDN | $829.57 | $2,711.00 | 69% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DX/THER SBST INTERLAMINAR LMBR/SAC WO IMG GDN | $891.38 | $2,913.00 | 69% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG | $1,050.19 | $3,432.00 | 69% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG | $1,075.59 | $3,515.00 | 69% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG | $1,050.19 | $3,432.00 | 69% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES/STEROID EPIDURAL LUMBAR/SACRAL SINGLE LEVEL W IMG | $1,075.59 | $3,515.00 | 69% |
| Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $484.09 | $1,582.00 | 69% |
| Prostate biopsy CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,149.34 | $3,756.00 | 69% |
| Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $484.09 | $1,582.00 | 69% |
| Prostate biopsy inpatient CPT 55700 PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,149.34 | $3,756.00 | 69% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAP, PROSTATECTOMY, RADICAL, W/NERVE SPARE | $6,667.43 | $21,789.00 | 69% |
| Prostate removal (prostatectomy), laparoscopic inpatient CPT 55866 LAP, PROSTATECTOMY, RADICAL, W/NERVE SPARE | $6,667.43 | $21,789.00 | 69% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,123.63 | $3,672.00 | 69% |
| Removal of a breast lump, open surgery CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,690.34 | $5,524.00 | 69% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,123.63 | $3,672.00 | 69% |
| Removal of a breast lump, open surgery inpatient CPT 19120 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $1,690.34 | $5,524.00 | 69% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 SURGICAL ARTHROSCOPY SHOULDER W CORACOACRM LIGAMENT RELEASE | $4,078.98 | $13,330.00 | 69% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) inpatient CPT 29826 SURGICAL ARTHROSCOPY SHOULDER W CORACOACRM LIGAMENT RELEASE | $4,078.98 | $13,330.00 | 69% |
| Tonsil and adenoid removal, child under 12 CPT 42820 REMOVE TONSILS/ADENOIDS, <12 Y/O | $1,274.49 | $4,165.00 | 69% |
| Tonsil and adenoid removal, child under 12 inpatient CPT 42820 REMOVE TONSILS/ADENOIDS, <12 Y/O | $1,274.49 | $4,165.00 | 69% |
| Total hip replacement CPT 27130 ARTHROPLASTY ACETABULAR/PROX FEM PROSTC AGRFT/ALGRFT | $7,845.23 | $25,638.00 | 69% |
| Total hip replacement inpatient CPT 27130 ARTHROPLASTY ACETABULAR/PROX FEM PROSTC AGRFT/ALGRFT | $7,845.23 | $25,638.00 | 69% |
| Total knee replacement CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL & LAT COMPARTMENTS | $8,027.60 | $26,234.00 | 69% |
| Total knee replacement inpatient CPT 27447 ARTHROPLASTY KNEE CONDYLE & PLATEAU MEDIAL & LAT COMPARTMENTS | $8,027.60 | $26,234.00 | 69% |
| Upper endoscopy (EGD) with biopsy CPT 43239 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,166.78 | $3,813.00 | 69% |
| Upper endoscopy (EGD) with biopsy CPT 43239 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,205.33 | $3,939.00 | 69% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,166.78 | $3,813.00 | 69% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL BIOPSY SINGLE/MULTIPLE | $1,205.33 | $3,939.00 | 69% |
| Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,146.58 | $3,747.00 | 69% |
| Upper endoscopy (EGD), diagnostic CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,379.75 | $4,509.00 | 69% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,146.58 | $3,747.00 | 69% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $1,379.75 | $4,509.00 | 69% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN | $3,376.40 | $11,034.00 | 69% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN | $4,162.82 | $13,604.00 | 69% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN | $3,376.40 | $11,034.00 | 69% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care inpatient CPT 59610 ROUTINE OB CARE VAG DELIVERY & POSTPARTUM CARE AFTER PREVIOUS CESAREAN | $4,162.82 | $13,604.00 | 69% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM | $2,705.65 | $8,842.00 | 69% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM | $4,123.35 | $13,475.00 | 69% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM | $2,705.65 | $8,842.00 | 69% |
| Vaginal delivery, including prenatal and postpartum care inpatient CPT 59400 OB CARE INCL ANTEPARTUM, VAGINAL DELIVERY AND POSTPARTUM | $4,123.35 | $13,475.00 | 69% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 ECG W AT LEAST 12 LEADS W INTERP & RPT (GLOBAL) | $147.80 | $483.00 | 69% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 ECG W AT LEAST 12 LEADS W INTERP & RPT (GLOBAL) | $147.80 | $483.00 | 69% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY W PATIENT PRESENT 50 MINS | $157.28 | $514.00 | 69% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 FAMILY PSYCHOTHERAPY W PATIENT PRESENT 50 MINS | $157.28 | $514.00 | 69% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY | $58.75 | $192.00 | 69% |
| Group psychotherapy session inpatient CPT 90853 GROUP PSYCHOTHERAPY | $58.75 | $192.00 | 69% |
| New patient office visit, about 30 minutes CPT 99203 WOUND CENTER, NEW PT, LOW, 30 MIN | $165.55 | $541.00 | 69% |
| New patient office visit, about 30 minutes CPT 99203 NEW PT, LOW, 30 MIN | $165.55 | $541.00 | 69% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PT, LOW, 30 MIN | $165.55 | $541.00 | 69% |
| New patient office visit, about 30 minutes inpatient CPT 99203 WOUND CENTER, NEW PT, LOW, 30 MIN | $165.55 | $541.00 | 69% |
| New patient office visit, about 45 minutes CPT 99204 NEW PT, MOD, 45 MIN | $244.19 | $798.00 | 69% |
| New patient office visit, about 45 minutes CPT 99204 WOUND CENTER, NEW PT, MOD, 45 MIN | $244.19 | $798.00 | 69% |
| New patient office visit, about 45 minutes inpatient CPT 99204 WOUND CENTER, NEW PT, MOD, 45 MIN | $244.19 | $798.00 | 69% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PT, MOD, 45 MIN | $244.19 | $798.00 | 69% |
| New patient office visit, about 60 minutes CPT 99205 WOUND CENTER, NEW PT, HIGH, 60 MIN | $305.69 | $999.00 | 69% |
| New patient office visit, about 60 minutes CPT 99205 NEW PT, HIGH, 60 MIN | $305.69 | $999.00 | 69% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PT, HIGH, 60 MIN | $305.69 | $999.00 | 69% |
| New patient office visit, about 60 minutes inpatient CPT 99205 WOUND CENTER, NEW PT, HIGH, 60 MIN | $305.69 | $999.00 | 69% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EX EA 15 MIN | $30.60 | $100.00 | 69% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EX EA 15 MIN | $30.60 | $100.00 | 69% |
| Preventive checkup, new patient aged 18–39 CPT 99385 INITIAL PREVENTIVE MED NEW PATIENT 18-39 YRS | $207.77 | $679.00 | 69% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 INITIAL PREVENTIVE MED NEW PATIENT 18-39 YRS | $207.77 | $679.00 | 69% |
| Preventive checkup, new patient aged 40–64 CPT 99386 INITIAL PREVENTIVE MED NEW PATIENT 40-64 YRS | $235.31 | $769.00 | 69% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 INITIAL PREVENTIVE MED NEW PATIENT 40-64 YRS | $235.31 | $769.00 | 69% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY W PATIENT 30 MINUTES | $72.83 | $238.00 | 69% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 PSYCHOTHERAPY W PATIENT 30 MINUTES | $72.83 | $238.00 | 69% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY W PATIENT 45 MINUTES | $143.51 | $469.00 | 69% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 PSYCHOTHERAPY W PATIENT 45 MINUTES | $143.51 | $469.00 | 69% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY W PATIENT 60 MINUTES | $179.32 | $586.00 | 69% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 PSYCHOTHERAPY W PATIENT 60 MINUTES | $179.32 | $586.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT, OP, 30 MIN | $271.42 | $887.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT, OP, LOW | $271.42 | $887.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULT, ED, LOW 30 MIN | $271.42 | $887.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT, OP, 30 MIN | $271.42 | $887.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT, OP, LOW | $271.42 | $887.00 | 69% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULT, ED, LOW 30 MIN | $271.42 | $887.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT, OP, 40 MIN | $335.38 | $1,096.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT, ED, MOD 40 MIN | $335.38 | $1,096.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULT, OP, MOD | $335.38 | $1,096.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT, OP, 40 MIN | $335.38 | $1,096.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT, OP, MOD | $335.38 | $1,096.00 | 69% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULT, ED, MOD 40 MIN | $335.38 | $1,096.00 | 69% |
Dental
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Dental implant, surgical placement CDT D6010 SURGICAL PLACEMENT OF IMPLANT BODY; ENDOSTEAL IMPLANT | $747.56 | $2,443.00 | 69% |
| Dental implant, surgical placement CDT D6010 SURGICAL PLACEMENT OF IMPLANT BODY; ENDOSTEAL IMPLANT | $1,181.77 | $3,862.00 | 69% |
| Dental implant, surgical placement inpatient CDT D6010 SURGICAL PLACEMENT OF IMPLANT BODY; ENDOSTEAL IMPLANT | $747.56 | $2,443.00 | 69% |
| Dental implant, surgical placement inpatient CDT D6010 SURGICAL PLACEMENT OF IMPLANT BODY; ENDOSTEAL IMPLANT | $1,181.77 | $3,862.00 | 69% |
Source file: https://www.dartmouth-hitchcock.org/02-0222140_Mary%20Hitchcock%20Memorial%20Hospital_standardcharges.zip