Mary Hitchcock Memorial Hospital

1 Medical Center Drive, Lebanon, NH 03756 · (603) 650-5000

Acute Care HospitalsVoluntary non-profit - PrivateCMS rating 3/5Lebanon, NH-VT metro Website ↗

Price file

Prices published

File dated 2026-01-01

14,919 price rows for 62 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines · metro median $28

$28

cash

$4 to $279

179 negotiated rates

$91

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · lowest of 2 lines · metro median $1,965

$1,965

cash

$169 to $6,100

81 negotiated rates

$6,421

list

CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines · metro median $868

$868

cash

$108 to $2,793

82 negotiated rates

$2,835

list

CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines · metro median $1,113

$1,113

cash

$164 to $3,454

82 negotiated rates

$3,636

list

Cataract surgery with lens implant

CPT 66984 · lowest of 2 lines · metro median $3,447

$3,447

cash

$388 to $12,403

148 negotiated rates

$11,265

list

Cesarean delivery with prenatal and postpartum care

CPT 59510 · lowest of 2 lines · metro median $4,523

$4,523

cash

$1,276 to $14,886

397 negotiated rates

$14,782

list

Chlamydia test (DNA)

CPT 87491 · lowest of 6 lines · metro median $13

$13

cash

$5 to $212

395 negotiated rates

$42

list

Colonoscopy (diagnostic)

CPT 45378 · lowest of 6 lines · metro median $1,279

$1,279

cash

$132 to $8,280

367 negotiated rates

$4,181

list

Colonoscopy with biopsy

CPT 45380 · lowest of 2 lines · metro median $1,322

$1,322

cash

$143 to $8,280

195 negotiated rates

$4,321

list

Colonoscopy with polyp removal

CPT 45385 · lowest of 2 lines · metro median $1,322

$1,322

cash

$181 to $8,280

195 negotiated rates

$4,321

list

Complete blood count (CBC) with differential

CPT 85025 · lowest of 4 lines · metro median $16

$16

cash

$3 to $96

230 negotiated rates

$53

list

Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines · metro median $49

$49

cash

$4 to $153

179 negotiated rates

$161

list

Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 2 lines · metro median $335

$335

cash

$124 to $1,041

76 negotiated rates

$1,096

list

Electrocardiogram (ECG) with interpretation

CPT 93000 · lowest of 2 lines · metro median $148

$148

cash

$10 to $459

358 negotiated rates

$483

list

Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 6 lines · metro median $215

$215

cash

$80 to $3,913

402 negotiated rates

$702

list

Family psychotherapy with the patient

CPT 90847 · lowest of 2 lines · metro median $157

$157

cash

$58 to $700

331 negotiated rates

$514

list

Family psychotherapy without the patient

CPT 90846

—

cash

$73 to $700

286 negotiated rates

—

list

Gallbladder removal (laparoscopic)

CPT 47562 · lowest of 2 lines · metro median $3,482

$3,482

cash

$447 to $25,404

159 negotiated rates

$11,378

list

Gonorrhea test (DNA)

CPT 87591 · lowest of 6 lines · metro median $13

$13

cash

$5 to $212

395 negotiated rates

$42

list

Group psychotherapy

CPT 90853 · lowest of 2 lines · metro median $59

$59

cash

$18 to $403

334 negotiated rates

$192

list

Inguinal hernia repair (age 5 and up)

CPT 49505 · lowest of 2 lines · metro median $2,075

$2,075

cash

$384 to $15,366

148 negotiated rates

$6,781

list

Knee arthroscopy with meniscus repair

CPT 29881 · lowest of 2 lines · metro median $3,884

$3,884

cash

$401 to $14,128

148 negotiated rates

$12,692

list

Laser treatment after cataract surgery (YAG)

CPT 66821 · lowest of 2 lines · metro median $959

$959

cash

$222 to $7,726

193 negotiated rates

$3,135

list

Left heart catheterization

CPT 93452 · lowest of 2 lines · metro median $6,895

$6,895

cash

$415 to $21,405

81 negotiated rates

$22,532

list

Lipid panel (cholesterol test)

CPT 80061 · lowest of 4 lines · metro median $47

$47

cash

$6 to $171

224 negotiated rates

$154

list

Liver function panel

CPT 80076 · lowest of 2 lines · metro median $26

$26

cash

$3 to $261

357 negotiated rates

$84

list

MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines · metro median $2,295

$2,295

cash

$322 to $7,124

82 negotiated rates

$7,499

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · lowest of 2 lines · metro median $1,585

$1,585

cash

$205 to $5,225

82 negotiated rates

$5,181

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · lowest of 2 lines · metro median $1,559

$1,559

cash

$193 to $4,841

82 negotiated rates

$5,096

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines · metro median $1,640

$1,640

cash

$192 to $5,092

82 negotiated rates

$5,360

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · lowest of 2 lines · metro median $1,076

$1,076

cash

$80 to $7,726

197 negotiated rates

$3,515

list

New patient office visit (about 30 minutes)

CPT 99203 · lowest of 4 lines · metro median $166

$166

cash

$59 to $558

357 negotiated rates

$541

list

New patient office visit (about 45 minutes)

CPT 99204 · lowest of 4 lines · metro median $244

$244

cash

$90 to $847

357 negotiated rates

$798

list

New patient office visit (about 60 minutes)

CPT 99205 · lowest of 4 lines · metro median $306

$306

cash

$113 to $1,065

357 negotiated rates

$999

list

PSA test (prostate)

CPT 84153 · lowest of 6 lines · metro median $17

$17

cash

$6 to $132

447 negotiated rates

$56

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 4 lines · metro median $20

$20

cash

$3 to $103

402 negotiated rates

$64

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 2 lines · metro median $31

$31

cash

$11 to $203

326 negotiated rates

$100

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines · metro median $429

$429

cash

$68 to $1,333

83 negotiated rates

$1,403

list

Preventive visit, new patient age 18 to 39

CPT 99385 · lowest of 2 lines · metro median $208

$208

cash

$43 to $783

298 negotiated rates

$679

list

Preventive visit, new patient age 40 to 64

CPT 99386 · lowest of 2 lines · metro median $235

$235

cash

$43 to $909

298 negotiated rates

$769

list

Prostate biopsy

CPT 55700 · lowest of 2 lines · metro median $1,149

$1,149

cash

$93 to $8,920

197 negotiated rates

$3,756

list

Prostate removal (laparoscopic)

CPT 55866 · lowest of 2 lines · metro median $6,667

$6,667

cash

$861 to $45,333

174 negotiated rates

$21,789

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 2 lines · metro median $21

$21

cash

$3 to $98

179 negotiated rates

$69

list

Psychotherapy, 30 minutes

CPT 90832 · lowest of 2 lines · metro median $73

$73

cash

$27 to $700

331 negotiated rates

$238

list

Psychotherapy, 45 minutes

CPT 90834 · lowest of 2 lines · metro median $144

$144

cash

$53 to $700

331 negotiated rates

$469

list

Psychotherapy, 60 minutes

CPT 90837 · lowest of 2 lines · metro median $179

$179

cash

$66 to $700

331 negotiated rates

$586

list

Removal of a breast lump (biopsy by excision)

CPT 19120 · lowest of 2 lines · metro median $1,690

$1,690

cash

$307 to $16,673

193 negotiated rates

$5,524

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 2 lines · metro median $293

$293

cash

$109 to $911

76 negotiated rates

$959

list

Shoulder arthroscopy with decompression

CPT 29826 · lowest of 2 lines · metro median $4,079

$4,079

cash

$124 to $12,664

283 negotiated rates

$13,330

list

Sleep study (overnight, attended)

CPT 95810

—

cash

$173 to $4,430

30 negotiated rates

—

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · lowest of 2 lines · metro median $891

$891

cash

$56 to $7,726

175 negotiated rates

$2,913

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · lowest of 2 lines · metro median $956

$956

cash

$71 to $7,726

188 negotiated rates

$3,125

list

TSH test (thyroid)

CPT 84443 · lowest of 4 lines · metro median $17

$17

cash

$6 to $218

224 negotiated rates

$55

list

Tonsils and adenoids removal (under age 12)

CPT 42820 · lowest of 2 lines · metro median $1,274

$1,274

cash

$214 to $25,758

148 negotiated rates

$4,165

list

Transvaginal ultrasound

CPT 76830 · lowest of 4 lines · metro median $144

$144

cash

$53 to $1,125

128 negotiated rates

$470

list

Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines · metro median $505

$505

cash

$106 to $1,567

83 negotiated rates

$1,649

list

Upper endoscopy (EGD)

CPT 43235 · lowest of 2 lines · metro median $1,380

$1,380

cash

$88 to $8,280

195 negotiated rates

$4,509

list

Upper endoscopy with biopsy

CPT 43239 · lowest of 2 lines · metro median $1,205

$1,205

cash

$99 to $8,280

195 negotiated rates

$3,939

list

Urinalysis with microscope

CPT 81001 · lowest of 2 lines · metro median $50

$50

cash

$2 to $156

357 negotiated rates

$164

list

Vaginal delivery after a previous cesarean

CPT 59610 · lowest of 2 lines · metro median $4,163

$4,163

cash

$1,250 to $14,621

401 negotiated rates

$13,604

list

Vaginal delivery with prenatal and postpartum care

CPT 59400 · lowest of 2 lines · metro median $4,123

$4,123

cash

$1,002 to $12,801

397 negotiated rates

$13,475

list

X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines · metro median $320

$320

cash

$27 to $995

83 negotiated rates

$1,047

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://www.dartmouth-hitchcock.org/02-0222140_Mary%20Hitchcock%20Memorial%20Hospital_standardcharges.zip
MARY HITCHCOCK MEMORIAL HOSPITAL · parsed · wide v3.0.0 · file dated 2026-01-01 · 28.2 MB · 14919 price rows read · read Nov 2026