Dartmouth Health - Clinics

1 Medical Center Drive Lebanon, NH 03766
http://www.dartmouth-hitchcock.org/index.html
(603) 650-5000

All cost information is based on claims data collected in the New Hampshire Comprehensive Healthcare Information System which is updated quarterly. All quality information is based on claims and administrative data collected by the Centers for Medicare and Medicaid Services which is updated annually. For more information click the links above and review our methodology section.

Methodology
Procedure Estimate of Procedure Cost Estimate of Procedure Cost
This is an estimate of the total charge for the health care service before any discounts provided to the uninsured. 		Number of Visits Number of Visits
When the number of visits varies, it is difficult to estimate the total cost of care. This indicates the number of visits you can expect, calculated using the median. To determine the total you might pay, multiply the Estimate of Procedure Cost and the Statewide Average for Number of Visits.
- Above Average: Expect to visit the provider more than the average number of visits.
- Near Average: Expect the visit the provider close to the average number of visits.
- Below Average: Expect to visit the provider less than the average number of visits.
 		What You Will Pay What You Will Pay
The estimated charge amount minus the uninsured discount (when available).
Uninsured Discount: 62%
Application of Blood Vessel Compression or Decompression Device $53 Below Average
State Average: 3
 $20
Arthrocentesis $1,174 N/A $446
Back MRI $4,590 N/A $1,744
Biopsy of Skin Lesion $2,067 N/A $786
Blood Count (Hemoglobin) $53 N/A $20
Blood Glucose (Sugar) Level $26 N/A $10
Blood Glucose Control (Hemoglobin A1C) $61 N/A $23
Bone Density Scan $989 N/A $376
Brain MRI $10,243 N/A $3,892
Chlamydia Test $69 N/A $26
Cholesterol Test, Lipid Panel $154 N/A $59
Clotting Time $19 N/A $7
Comprehensive Eye Exam $152 N/A $58
Comprehensive Eye Exam, New Patient $179 N/A $68
CT Scan of Abdomen and Pelvis, With Contrast $3,714 N/A $1,411
CT Scan of Chest, With Contrast $2,952 N/A $1,122
CT Scan of Pelvis, With Contrast $859 N/A $327
Detection for Strep (Streptococcus, group A) $28 N/A $11
Developmental Screening $36 N/A $14
Diagnostic Imaging of Optic Nerve in Eye $47 N/A $18
Diagnostic Mammogram of Both Breasts $750 N/A $285
Diagnostic Mammogram of One Breast $654 N/A $249
Electrical Stimulation Therapy $29 Below Average
State Average: 3
 $11
Electrocardiogram (ECG or EKG) With Report and Interpretation $483 N/A $184
Electrocardiogram (ECG or EKG) With Tracing $313 N/A $119
Electrocardiogram (ECG or EKG), Report and Interpretation Only $170 N/A $65
Family Psychotherapy with Patient $202 Below Average
State Average: 3
 $77
Family Psychotherapy without Patient $163 Near Average
State Average: 1
 $62
General Health Panel $122 N/A $46
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $69 N/A $26
Group Psychotherapy $192 Near Average
State Average: 4
 $73
Hepatitis A Vaccine for Children, Injected into Muscle $485 N/A $184
High Complexity Physical Therapy Evaluation $189 Near Average
State Average: 1
 $72
Human Papilloma Virus Vaccine, Injected into Muscle $66 N/A $25
Injection of Substance for Pain Management, Lower Back or Tailbone $3,116 N/A $1,184
Knee MRI $3,713 N/A $1,411
Lead Level $125 N/A $47
Low Back MRI, Before and After Contrast $3,637 N/A $1,382
Low Complexity Physical Therapy Evaluation $215 Near Average
State Average: 1
 $82
Manual Physical Therapy $58 Below Average
State Average: 4
 $22
Moderate Complexity Physical Therapy Evaluation $189 Near Average
State Average: 1
 $72
Neuromuscular Reeducation $68 Below Average
State Average: 4
 $26
New Patient Preventive Care Visit for Adult, 40-64 $569 N/A $216
New Patient Preventive Care Visit for Adult, Ages 18-39 $641 N/A $243
New Patient Preventive Care Visit for Child, Ages 5-11 $418 N/A $159
New Patient Preventive Care Visit for Child, Under Age 1 $552 N/A $210
Office Visit for Established Patient, Basic $225 N/A $85
Office Visit for Established Patient, High Complexity $702 N/A $267
Office Visit for Established Patient, Low Complexity $312 N/A $119
Office Visit for Established Patient, Minimal Presenting Problem $144 N/A $55
Office Visit for Established Patient, Moderate Complexity $341 N/A $130
Office Visit for New Patient, High Complexity $943 N/A $358
Office Visit for New Patient, Low Complexity $510 N/A $194
Office Visit for New Patient, Minor Complexity $327 N/A $124
Office Visit for New Patient, Moderate Complexity $753 N/A $286
Pap Test Screening, Automated with Manual Review $311 N/A $118
Pelvis MRI $9,106 N/A $3,460
Physical Therapy Re-Evaluation $131 Near Average
State Average: 1
 $50
Pregnancy Test $89 N/A $34
Preventive Care Visit for Adolescent, Under Ages 12-17 $347 N/A $132
Preventive Care Visit for Adult, 40-64 $596 N/A $227
Preventive Care Visit for Adult, Ages 18-39 $355 N/A $135
Preventive Care Visit for Child, Under Age 1 $297 N/A $113
Preventive Care Visit for Child, Under Ages 1-4 $316 N/A $120
Preventive Care Visit for Child, Under Ages 5-11 $315 N/A $120
Psychiatric Diagnostic Evaluation $221 Near Average
State Average: 1
 $84
Psychotherapy, 30 Minutes with Patient $158 Near Average
State Average: 1
 $60
Psychotherapy, 45 Minutes with Patient $150 Below Average
State Average: 3
 $57
Psychotherapy, 60 Minutes with Patient $168 Near Average
State Average: 6
 $64
Screening Mammogram of Both Breasts $820 N/A $312
Self-Care or Home Management Training $63 Near Average
State Average: 2
 $24
Single-Level Injection for Pain Management, Lower Back or Tailbone $3,479 N/A $1,322
Skin Growth Removal, Premalignant or Precancerous $926 N/A $352
Skin Growth Removal, Up to 14, Benign or Noncancerous $1,021 N/A $388
Sleep Monitoring $3,805 N/A $1,446
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $66 N/A $25
Therapeutic Activities $74 Below Average
State Average: 3
 $28
Therapeutic Exercises $63 Below Average
State Average: 4
 $24
Ultrasound of Breast $526 N/A $200
Ultrasound of Heart (Echocardiogram) $4,041 N/A $1,536
Ultrasound of Pelvis $826 N/A $314
Urinalysis, Manual Test $8 N/A $3
X-Ray of Chest, 1 View $143 N/A $54
X-Ray of Chest, 2 Views $368 N/A $140
X-Ray of Fingers, 2 Views $222 N/A $84
X-Ray of Hand, 2 Views $407 N/A $155
X-Ray of Knee, 1 or 2 Views $307 N/A $117
X-Ray of Knee, 4 Views $355 N/A $135
X-Ray of Low Back, 4 Views $475 N/A $180
X-Ray of Lower Leg, 2 Views $298 N/A $113
X-Ray of Neck, 4 to 5 Views $545 N/A $207