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 $810 N/A $810
Bacterial Culture, Quantitative Colony Count $74 N/A $74
Basic Metabolic Panel $83 N/A $83
Biopsy of Skin Lesion $1,712 N/A $1,712
Blood Count (Hemoglobin) $47 N/A $47
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Blood Typing (ABO) $39 N/A $39
Blood Typing (Rh (D)) $64 N/A $64
Bone Density Scan $267 N/A $267
Chlamydia Test $144 N/A $144
Cholesterol Test, Lipid Panel $150 N/A $150
Clotting Time $79 N/A $79
Coagulation Assessment $57 N/A $57
Complete Blood Cell Count (Hemoglobin) $48 N/A $48
Complete Blood Cell Count and Automated White Blood Cells $93 N/A $93
Comprehensive Metabolic Panel $97 N/A $97
CT Scan of Abdomen and Pelvis, With Contrast $2,791 N/A $2,791
CT Scan of Chest, With Contrast $1,015 N/A $1,015
Detection for Strep (Streptococcus, group A) $118 N/A $118
Detection Test for Hepatitis B Surface Antigen $119 N/A $119
Developmental Screening $77 N/A $77
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 $235 N/A $235
Electrocardiogram (ECG or EKG), Report and Interpretation Only $131 N/A $131
General Health Panel $273 N/A $273
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $99 N/A $99
Group Psychotherapy $146 Below Average
State Average: 4
 $146
Hepatitis A Vaccine for Children, Injected into Muscle $365 N/A $365
Hepatitis C Antibody Level $114 N/A $114
Human Papilloma Virus Vaccine, Injected into Muscle $67 N/A $67
Influenza Vaccine, Injected into Muscle $60 N/A $60
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) $158 N/A $158
Lab Test to Detect Coronavirus (COVID-19) Antigen $110 N/A $110
Lab Test to Detect HIV-1 and HIV-2 $139 N/A $139
Lab Test to Measure Creatinine Level $183 N/A $183
Microalbumin (Protein) Level $142 N/A $142
Moderate Complexity Physical Therapy Evaluation $381 Near Average
State Average: 1
 $381
Nasal Endoscopy $1,247 N/A $1,247
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $501 N/A $501
New Patient Preventive Care Visit for Adult, 40-64 $583 N/A $583
New Patient Preventive Care Visit for Adult, Ages 18-39 $376 N/A $376
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 $450 N/A $450
Office Visit for Established Patient, Basic $179 N/A $179
Office Visit for Established Patient, High Complexity $543 N/A $543
Office Visit for Established Patient, Low Complexity $273 N/A $273
Office Visit for Established Patient, Minimal Presenting Problem $108 N/A $108
Office Visit for Established Patient, Moderate Complexity $402 N/A $402
Office Visit for New Patient, High Complexity $773 N/A $773
Office Visit for New Patient, Low Complexity $418 N/A $418
Office Visit for New Patient, Minor Complexity $192 N/A $192
Office Visit for New Patient, Moderate Complexity $617 N/A $617
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
Pelvis MRI $1,512 N/A $1,512
Pneumococcal Vaccine for Children, Injected into Muscle $67 N/A $67
Pregnancy Test $62 N/A $62
Preventive Care Visit for Adolescent, Under Ages 12-17 $437 N/A $437
Preventive Care Visit for Adult, 40-64 $308 N/A $308
Preventive Care Visit for Adult, Ages 18-39 $437 N/A $437
Preventive Care Visit for Child, Under Age 1 $358 N/A $358
Preventive Care Visit for Child, Under Ages 1-4 $401 N/A $401
Preventive Care Visit for Child, Under Ages 5-11 $401 N/A $401
Psychiatric Diagnostic Evaluation $201 Near Average
State Average: 1
 $201
Psychotherapy, 30 Minutes with Patient $206 Near Average
State Average: 1
 $206
Psychotherapy, 45 Minutes with Patient $129 Below Average
State Average: 4
 $129
Psychotherapy, 60 Minutes with Patient $171 Above Average
State Average: 6
 $171
Rotovirus Vaccine, Oral Administration $67 N/A $67
Screening Mammogram of Both Breasts $443 N/A $443
Skin Growth Removal, Premalignant or Precancerous $755 N/A $755
Skin Growth Removal, Up to 14, Benign or Noncancerous $772 N/A $772
Telehealth Visit for Established Patient, 11-20 minutes $115 N/A $115
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 $23 N/A $23
Thyroid Stimulating Hormone (TSH) Level $250 N/A $250
Thyroxine (Thyroid Chemical) Level, Free $155 N/A $155
Ultrasound of Heart (Echocardiogram) $2,063 N/A $2,063
Urinalysis, Automated with Microscope Examination $50 N/A $50
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $124 N/A $124
Vitamin D-3 Level $171 N/A $171
X-Ray of Chest, 2 Views $328 N/A $328
X-Ray of Fingers, 2 Views $307 N/A $307
X-Ray of Hand, 2 Views $646 N/A $646
X-Ray of Knee, 1 or 2 Views $265 N/A $265
X-Ray of Knee, 4 Views $617 N/A $617
X-Ray of Shoulder, 2 Views $621 N/A $621