Dartmouth Health

One Medical Center Drive Lebanon, NH 03756
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: 0%
Arthrocentesis $840 N/A $840
Back MRI $1,221 N/A $1,221
Bacterial Culture Swab for Aerobic Isolates $95 N/A $95
Bacterial Culture, Quantitative Colony Count $179 N/A $179
Basic Metabolic Panel $87 N/A $87
Biopsy of Skin Lesion $1,771 N/A $1,771
Blood Count (Hemoglobin) $51 N/A $51
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Bone Density Scan $267 N/A $267
Brain MRI $3,074 N/A $3,074
Chlamydia Test $207 N/A $207
Cholesterol Test, Lipid Panel $156 N/A $156
Clotting Time $63 N/A $63
Coagulation Assessment $57 N/A $57
Complete Blood Cell Count (Hemoglobin) $47 N/A $47
Complete Blood Cell Count and Automated White Blood Cells $85 N/A $85
Comprehensive Metabolic Panel $109 N/A $109
CT Scan of Abdomen and Pelvis, With Contrast $3,146 N/A $3,146
CT Scan of Chest, With Contrast $1,015 N/A $1,015
Detection for Strep (Streptococcus, group A) $124 N/A $124
Developmental Screening $82 N/A $82
Diagnostic Laryngoscopy $1,604 N/A $1,604
Electrocardiogram (ECG or EKG) With Report and Interpretation $366 N/A $366
Electrocardiogram (ECG or EKG) With Tracing $150 N/A $150
Electrocardiogram (ECG or EKG), Report and Interpretation Only $147 N/A $147
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $160 N/A $160
General Health Panel $273 N/A $273
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $120 N/A $120
Group Psychotherapy $166 Below Average
State Average: 5
 $166
Hepatitis A Vaccine for Children, Injected into Muscle $271 N/A $271
Hepatitis B Surface Antibody Level $64 N/A $64
Hepatitis C Antibody Level $84 N/A $84
Human Papilloma Virus Vaccine, Injected into Muscle $45 N/A $45
Influenza Vaccine, Injected into Muscle $59 N/A $59
Knee MRI $2,537 N/A $2,537
Lab Test to Detect Coronavirus (COVID-19) $200 N/A $200
Lab Test to Detect Coronavirus (COVID-19) Antigen $114 N/A $114
Lab Test to Measure Creatinine Level $189 N/A $189
Low Complexity Physical Therapy Evaluation $259 Near Average
State Average: 1
 $259
Magnesium Level $40 N/A $40
Manual Physical Therapy $116 Above Average
State Average: 4
 $116
Microalbumin (Protein) Level $204 N/A $204
Moderate Complexity Physical Therapy Evaluation $362 Near Average
State Average: 1
 $362
Nasal Endoscopy $1,286 N/A $1,286
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $544 N/A $544
New Patient Preventive Care Visit for Adult, 40-64 $446 N/A $446
New Patient Preventive Care Visit for Adult, Ages 18-39 $376 N/A $376
New Patient Preventive Care Visit for Child, Ages 1-4 $292 N/A $292
New Patient Preventive Care Visit for Child, Ages 5-11 $265 N/A $265
New Patient Preventive Care Visit for Child, Under Age 1 $478 N/A $478
Office Visit for Established Patient, Basic $179 N/A $179
Office Visit for Established Patient, High Complexity $608 N/A $608
Office Visit for Established Patient, Low Complexity $286 N/A $286
Office Visit for Established Patient, Minimal Presenting Problem $124 N/A $124
Office Visit for Established Patient, Moderate Complexity $440 N/A $440
Office Visit for New Patient, High Complexity $865 N/A $865
Office Visit for New Patient, Low Complexity $468 N/A $468
Office Visit for New Patient, Minor Complexity $239 N/A $239
Office Visit for New Patient, Moderate Complexity $691 N/A $691
Pap Test Screening, Automated with Manual Review $170 N/A $170
Parathyroid Hormone (PTH) Level $69 N/A $69
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $310
Pelvis MRI $1,512 N/A $1,512
Pneumococcal Vaccine for Children, Injected into Muscle $23 N/A $23
Pregnancy Test $62 N/A $62
Preventive Care Visit for Adolescent, Under Ages 12-17 $471 N/A $471
Preventive Care Visit for Adult, 40-64 $477 N/A $477
Preventive Care Visit for Adult, Ages 18-39 $471 N/A $471
Preventive Care Visit for Child, Under Age 1 $401 N/A $401
Preventive Care Visit for Child, Under Ages 1-4 $449 N/A $449
Preventive Care Visit for Child, Under Ages 5-11 $449 N/A $449
Prostate Specific Antigen (PSA) Level, Total $108 N/A $108
Psychiatric Diagnostic Evaluation $189 Near Average
State Average: 1
 $189
Psychotherapy, 30 Minutes with Patient $206 Near Average
State Average: 1
 $206
Psychotherapy, 45 Minutes with Patient $147 Below Average
State Average: 4
 $147
Psychotherapy, 60 Minutes with Patient $184 Below Average
State Average: 6
 $184
Red Blood Cell Sedimentation Rate, Non-Automated $70 N/A $70
Rotovirus Vaccine, Oral Administration $71 N/A $71
Screening Mammogram of Both Breasts $329 N/A $329
Skin Growth Removal, Premalignant or Precancerous $820 N/A $820
Skin Growth Removal, Up to 14, Benign or Noncancerous $810 N/A $810
Telehealth Visit for Established Patient, 11-20 minutes $183 N/A $183
Telehealth Visit for Established Patient, 21-30 minutes $244 N/A $244
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $23 N/A $23
Therapeutic Exercises $154 Below Average
State Average: 4
 $154
Thyroid Stimulating Hormone (TSH) Level $105 N/A $105
Ultrasound of Heart (Echocardiogram) $3,529 N/A $3,529
Urinalysis, Automated with Microscope Examination $162 N/A $162
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $145 N/A $145
Vitamin D-3 Level $171 N/A $171
X-Ray of Chest, 1 View $281 N/A $281
X-Ray of Chest, 2 Views $429 N/A $429
X-Ray of Fingers, 2 Views $308 N/A $308
X-Ray of Knee, 1 or 2 Views $265 N/A $265
X-Ray of Knee, 4 Views $603 N/A $603
X-Ray of Low Back, 4 Views $354 N/A $354
X-Ray of Lower Leg, 2 Views $267 N/A $267
X-Ray of Neck, 4 to 5 Views $466 N/A $466
X-Ray of Shoulder, 2 Views $711 N/A $711