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 $870 N/A $870
Bacterial Culture, Quantitative Colony Count $140 N/A $140
Basic Metabolic Panel $84 N/A $84
Biopsy of Skin Lesion $1,579 N/A $1,579
Blood Count (Hemoglobin) $47 N/A $47
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Blood Typing (ABO) $48 N/A $48
Blood Typing (Rh (D)) $95 N/A $95
Chlamydia Test $207 N/A $207
Cholesterol Test, Lipid Panel $144 N/A $144
Clotting Time $79 N/A $79
Complete Blood Cell Count (Hemoglobin) $48 N/A $48
Complete Blood Cell Count and Automated White Blood Cells $74 N/A $74
Comprehensive Metabolic Panel $97 N/A $97
CT Scan of Abdomen and Pelvis, With Contrast $6,777 N/A $6,777
Detection for Strep (Streptococcus, group A) $118 N/A $118
Detection Test for Hepatitis B Surface Antigen $90 N/A $90
Developmental Screening $74 N/A $74
Diagnostic Laryngoscopy $1,517 N/A $1,517
Ferritin (Blood Protein) Level $82 N/A $82
General Health Panel $273 N/A $273
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $107 N/A $107
Group Psychotherapy $146 Below Average
State Average: 4
 $146
Hepatic (Liver) Function Panel $49 N/A $49
Hepatitis A Vaccine for Children, Injected into Muscle $449 N/A $449
Hepatitis C Antibody Level $84 N/A $84
Human Papilloma Virus Vaccine, Injected into Muscle $46 N/A $46
Influenza Vaccine, Injected into Muscle $97 N/A $97
Iron Binding Capacity $101 N/A $101
Iron Level $63 N/A $63
Knee MRI $3,123 N/A $3,123
Lab Test to Detect Coronavirus (COVID-19) $107 N/A $107
Lab Test to Detect Coronavirus (COVID-19) Antigen $110 N/A $110
Lab Test to Detect HIV-1 and HIV-2 $167 N/A $167
Low Complexity Physical Therapy Evaluation $195 Near Average
State Average: 1
 $195
Nasal Endoscopy $1,419 N/A $1,419
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $501 N/A $501
New Patient Preventive Care Visit for Adult, 40-64 $372 N/A $372
New Patient Preventive Care Visit for Adult, Ages 18-39 $341 N/A $341
New Patient Preventive Care Visit for Child, Ages 1-4 $282 N/A $282
New Patient Preventive Care Visit for Child, Ages 5-11 $255 N/A $255
New Patient Preventive Care Visit for Child, Under Age 1 $422 N/A $422
Office Visit for Established Patient, Basic $108 N/A $108
Office Visit for Established Patient, High Complexity $543 N/A $543
Office Visit for Established Patient, Low Complexity $255 N/A $255
Office Visit for Established Patient, Minimal Presenting Problem $81 N/A $81
Office Visit for Established Patient, Moderate Complexity $265 N/A $265
Office Visit for New Patient, High Complexity $773 N/A $773
Office Visit for New Patient, Low Complexity $216 N/A $216
Office Visit for New Patient, Minor Complexity $275 N/A $275
Office Visit for New Patient, Moderate Complexity $320 N/A $320
Pap Test Screening, Automated with Manual Review $162 N/A $162
Parathyroid Hormone (PTH) Level $69 N/A $69
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $310
Pneumococcal Vaccine for Children, Injected into Muscle $65 N/A $65
Pregnancy Test $62 N/A $62
Preventive Care Visit for Adolescent, Under Ages 12-17 $405 N/A $405
Preventive Care Visit for Adult, 40-64 $308 N/A $308
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 $182 Near Average
State Average: 1
 $182
Rotovirus Vaccine, Oral Administration $67 N/A $67
Skin Growth Removal, Premalignant or Precancerous $684 N/A $684
Skin Growth Removal, Up to 14, Benign or Noncancerous $741 N/A $741
Smear for Microorganism $169 N/A $169
Telehealth Visit for Established Patient, 11-20 minutes $175 N/A $175
Telehealth Visit for Established Patient, 21-30 minutes $244 N/A $244
Telehealth Visit for Established Patient, 5-10 minutes $32 N/A $32
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $44 N/A $44
Thyroid Stimulating Hormone (TSH) Level $101 N/A $101
Thyroxine (Thyroid Chemical) Level, Free $155 N/A $155
Urinalysis, Automated without Microscope $110 N/A $110
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $573 N/A $573
Vitamin D-3 Level $171 N/A $171
X-Ray of Chest, 2 Views $737 N/A $737
X-Ray of Foot, 3 Views $727 N/A $727
X-Ray of Hand, 3 Views $887 N/A $887
X-Ray of Hip, 2 or 3 Views $1,040 N/A $1,040
X-Ray of Knee, 4 Views $1,574 N/A $1,574
X-Ray of Shoulder, 2 Views $896 N/A $896