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 $702 N/A $702
Automated Pap Test Screening and Manual Rescreening $238 N/A $238
Automated with Microscope Examination $40 N/A $40
Automated without Microscope $60 N/A $60
Bacterial Culture Swab $194 N/A $194
Bacterial Culture, Quantitative Colony Count $113 N/A $113
Basic Metabolic Panel $62 N/A $62
Blood Count (Hemoglobin) $59 N/A $59
Blood Glucose Control (Hemoglobin A1C) $102 N/A $102
Blood Typing (ABO) $82 N/A $82
Blood Typing (Rh (D)) $113 N/A $113
Borrelia Burgdorferi (Lyme disease) Antibody Level $172 N/A $172
C-reactive Protein (CRP) Level $139 N/A $139
Chlamydia Test $235 N/A $235
Cholesterol Test, Lipid Panel $158 N/A $158
Clotting Time $13 N/A $13
Complete Blood Cell Count (Hemoglobin) $70 N/A $70
Complete Blood Cell Count and Automated White Blood Cells $74 N/A $74
Comprehensive Metabolic Panel $62 N/A $62
Coronavirus (COVID-19) Antibody Level $57 N/A $57
CT Scan of Abdomen and Pelvis, With Contrast $5,080 N/A $5,080
Detection for Strep (Streptococcus, group A) $107 N/A $107
Detection Test for Hepatitis B Surface Antigen $197 N/A $197
Detection Test for Human Papillomavirus (HPV) $294 N/A $294
Developmental Screening $70 N/A $70
Diagnostic Laryngoscopy $1,561 N/A $1,561
Electrocardiogram (ECG or EKG) With Report and Interpretation $502 N/A $502
Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) $186 N/A $186
Ferritin (Blood Protein) Level $153 N/A $153
General Health Panel $234 N/A $234
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $244 N/A $244
Group Psychotherapy $134 Above Average
State Average: 5
 $134
Hepatitis C Antibody Level $138 N/A $138
Influenza Vaccine, Injected into Muscle $62 N/A $62
Iron Binding Capacity $96 N/A $96
Iron Level $60 N/A $60
Knee MRI $3,621 N/A $3,621
Lab Test to Detect HIV-1 and HIV-2 $132 N/A $132
Lab Test to Detect Influenza Virus $88 N/A $88
Lab Test to Measure Creatinine Level $29 N/A $29
Lead Level $90 N/A $90
Low Complexity Physical Therapy Evaluation $299 Near Average
State Average: 1
 $299
Manual Pap Test Screening $189 N/A $189
Microalbumin (Protein) Level $85 N/A $85
Moderate Complexity Physical Therapy Evaluation $342 Near Average
State Average: 1
 $342
Nasal Endoscopy $1,199 N/A $1,199
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $282 N/A $282
New Patient Preventive Care Visit for Adult, 40-64 $332 N/A $332
New Patient Preventive Care Visit for Adult, Ages 18-39 $311 N/A $311
New Patient Preventive Care Visit for Child, Ages 1-4 $272 N/A $272
New Patient Preventive Care Visit for Child, Ages 5-11 $242 N/A $242
New Patient Preventive Care Visit for Child, Under Age 1 $389 N/A $389
Office Visit for Established Patient, Basic $104 N/A $104
Office Visit for Established Patient, High Complexity $501 N/A $501
Office Visit for Established Patient, Low Complexity $252 N/A $252
Office Visit for Established Patient, Minimal Presenting Problem $78 N/A $78
Office Visit for Established Patient, Moderate Complexity $372 N/A $372
Office Visit for New Patient, High Complexity $714 N/A $714
Office Visit for New Patient, Low Complexity $268 N/A $268
Office Visit for New Patient, Minor Complexity $264 N/A $264
Office Visit for New Patient, Moderate Complexity $359 N/A $359
Pathology Examination of Tissue, Intermediate Complexity $342 N/A $342
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 $387 N/A $387
Preventive Care Visit for Adult, 40-64 $439 N/A $439
Preventive Care Visit for Adult, Ages 18-39 $403 N/A $403
Preventive Care Visit for Child, Under Age 1 $204 N/A $204
Preventive Care Visit for Child, Under Ages 1-4 $324 N/A $324
Preventive Care Visit for Child, Under Ages 5-11 $324 N/A $324
Psychotherapy, 30 Minutes with Patient $167 Above Average
State Average: 1
 $167
Punch Biopsy of Skin $1,839 N/A $1,839
Screening Mammogram of Both Breasts $1,076 N/A $1,076
Skin Growth Removal, Premalignant or Precancerous $586 N/A $586
Skin Growth Removal, Up to 14, Benign or Noncancerous $681 N/A $681
Smear for Microorganism $113 N/A $113
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 $138 Near Average
State Average: 4
 $138
Thyroid Stimulating Hormone (TSH) Level $99 N/A $99
Ultrasound of Breast $616 N/A $616
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $528 N/A $528
Vitamin B-12 (Cyanocobalamin) Level $149 N/A $149
Vitamin D-3 Level $218 N/A $218
X-Ray of Chest, 2 Views $606 N/A $606
X-Ray of Foot $838 N/A $838
X-Ray of Hip $946 N/A $946
X-Ray of Shoulder $896 N/A $896