Dartmouth-Hitchcock Clinic

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 $968 N/A $968
Automated Pap Test Screening and Manual Rescreening $155 N/A $155
Automated with Microscope Examination $156 N/A $156
Automated without Microscope $104 N/A $104
Bacterial Culture, Quantitative Colony Count $141 N/A $141
Basic Metabolic Panel $82 N/A $82
Blood Count (Hemoglobin) $44 N/A $44
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Blood Typing (ABO) $48 N/A $48
Blood Typing (Rh (D)) $95 N/A $95
Borrelia Burgdorferi (Lyme disease) Antibody Level $172 N/A $172
C-reactive Protein (CRP) Level $33 N/A $33
Chlamydia Test $207 N/A $207
Cholesterol Test, Lipid Panel $155 N/A $155
Clotting Time $79 N/A $79
Complete Blood Cell Count (Hemoglobin) $46 N/A $46
Complete Blood Cell Count and Automated White Blood Cells $71 N/A $71
CT Scan of Abdomen and Pelvis, With Contrast $5,080 N/A $5,080
Detection Test for Hepatitis B Surface Antigen $62 N/A $62
Detection Test for Human Papillomavirus (HPV) $300 N/A $300
Developmental Screening $74 N/A $74
Diagnostic Laryngoscopy $1,561 N/A $1,561
Electrocardiogram (ECG or EKG) With Report and Interpretation $485 N/A $485
Electrocardiogram (ECG or EKG) With Tracing $612 N/A $612
Ferritin (Blood Protein) Level $82 N/A $82
General Health Panel $269 N/A $269
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $107 N/A $107
Group Psychotherapy $140 Below Average
State Average: 4
$140
Hepatic (Liver) Function Panel $49 N/A $49
Hepatitis C Antibody Level $84 N/A $84
Influenza Vaccine, Injected into Muscle $62 N/A $62
Knee MRI $3,662 N/A $3,662
Lab Test to Detect Coronavirus (COVID-19) $107 N/A $107
Lab Test to Detect Coronavirus (COVID-19) Antigen $53 N/A $53
Lab Test to Detect HIV-1 and HIV-2 $167 N/A $167
Lab Test to Measure Creatinine Level $175 N/A $175
Lead Level $90 N/A $90
Low Complexity Physical Therapy Evaluation $195 Near Average
State Average: 1
$195
Microalbumin (Protein) Level $190 N/A $190
Moderate Complexity Physical Therapy Evaluation $353 Near Average
State Average: 1
$353
Nasal Endoscopy $1,189 N/A $1,189
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $282 N/A $282
New Patient Preventive Care Visit for Adult, 40-64 $413 N/A $413
New Patient Preventive Care Visit for Adult, Ages 18-39 $311 N/A $311
New Patient Preventive Care Visit for Child, Ages 1-4 $282 N/A $282
New Patient Preventive Care Visit for Child, Ages 5-11 $442 N/A $442
New Patient Preventive Care Visit for Child, Under Age 1 $403 N/A $403
Office Visit for Established Patient, Basic $108 N/A $108
Office Visit for Established Patient, High Complexity $522 N/A $522
Office Visit for Established Patient, Low Complexity $261 N/A $261
Office Visit for Established Patient, Minimal Presenting Problem $78 N/A $78
Office Visit for Established Patient, Moderate Complexity $386 N/A $386
Office Visit for New Patient, High Complexity $743 N/A $743
Office Visit for New Patient, Low Complexity $210 N/A $210
Office Visit for New Patient, Minor Complexity $275 N/A $275
Office Visit for New Patient, Moderate Complexity $320 N/A $320
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $310
Pelvis MRI $6,271 N/A $6,271
Pneumococcal Conjugate Vaccine, Injected into Muscle $654 N/A $654
Pregnancy Test $62 N/A $62
Preventive Care Visit for Adolescent, Under Ages 12-17 $274 N/A $274
Preventive Care Visit for Adult, 40-64 $389 N/A $389
Preventive Care Visit for Adult, Ages 18-39 $419 N/A $419
Preventive Care Visit for Child, Under Age 1 $211 N/A $211
Preventive Care Visit for Child, Under Ages 1-4 $339 N/A $339
Preventive Care Visit for Child, Under Ages 5-11 $275 N/A $275
Psychotherapy, 30 Minutes with Patient $174 Near Average
State Average: 1
$174
Punch Biopsy of Skin $1,682 N/A $1,682
Screening Mammogram of Both Breasts $1,301 N/A $1,301
Skin Growth Removal, Premalignant or Precancerous $612 N/A $612
Skin Growth Removal, Up to 14, Benign or Noncancerous $710 N/A $710
Smear for Microorganism $169 N/A $169
Tangential Biopsy of Skin $1,437 N/A $1,437
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $163 N/A $163
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $144 N/A $144
Therapeutic Exercises $143 Below Average
State Average: 4
$143
Thyroid Stimulating Hormone (TSH) Level $101 N/A $101
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $550 N/A $550
Vitamin B-12 (Cyanocobalamin) Level $156 N/A $156
Vitamin D-3 Level $172 N/A $172
X-Ray of Ankle $751 N/A $751
X-Ray of Chest, 2 Views $856 N/A $856
X-Ray of Foot $727 N/A $727
X-Ray of Hand $920 N/A $920
X-Ray of Hip $983 N/A $983
X-Ray of Shoulder $896 N/A $896