Dartmouth-Hitchcock Medical Center

1 Medical Center Drive Lebanon, NH 03766
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: 62%
Application of Blood Vessel Compression or Decompression Device $53 Below Average
State Average: 2
 $20
Application of Mechanical Traction $53 Below Average
State Average: 3
 $20
Arthrocentesis $881 N/A $335
Back MRI $243 N/A $92
Bacterial Culture Swab $175 N/A $67
Bacterial Culture Swab for Aerobic Isolates $146 N/A $55
Bacterial Culture, Quantitative Colony Count $149 N/A $56
Basic Metabolic Panel $83 N/A $32
Bilirubin Level $42 N/A $16
Biopsy of Skin Lesion $2,241 N/A $851
Blood Count (Hemoglobin) $51 N/A $20
Blood Glucose (Sugar) Level $35 N/A $13
Blood Glucose Control (Hemoglobin A1C) $58 N/A $22
Blood Typing (ABO) $187 N/A $71
Blood Typing (Rh (D)) $231 N/A $88
Bone Density Scan $146 N/A $55
Brain MRI $8,865 N/A $3,369
Chlamydia Test $69 N/A $26
Cholesterol Test, Lipid Panel $146 N/A $55
Clotting Time $79 N/A $30
Complete Blood Cell Count (Hemoglobin) $53 N/A $20
Complete Blood Cell Count and Automated White Blood Cells $40 N/A $15
Comprehensive Eye Exam $152 N/A $58
Comprehensive Eye Exam, New Patient $179 N/A $68
Comprehensive Metabolic Panel $121 N/A $46
Creatinine Level $45 N/A $17
CT Scan of Abdomen and Pelvis, With Contrast $3,215 N/A $1,222
CT Scan of Chest, With Contrast $1,109 N/A $421
CT Scan of Pelvis, With Contrast $188 N/A $71
Detection for Strep (Streptococcus, group A) $27 N/A $10
Detection Test for Hepatitis B Surface Antigen $75 N/A $29
Detection Test for Human Papillomavirus (HPV) $384 N/A $146
Developmental Screening $34 N/A $13
Diagnostic Imaging of Optic Nerve in Eye $47 N/A $18
Diagnostic Mammogram of Both Breasts $718 N/A $273
Diagnostic Mammogram of One Breast $616 N/A $234
Electrocardiogram (ECG or EKG) With Report and Interpretation $53 N/A $20
Electrocardiogram (ECG or EKG) With Tracing $295 N/A $112
Electrocardiogram (ECG or EKG), Report and Interpretation Only $161 N/A $61
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $195 N/A $74
Family Psychotherapy with Patient $205 Below Average
State Average: 3
 $78
Family Psychotherapy without Patient $163 Above Average
State Average: 1
 $62
Ferritin (Blood Protein) Level $82 N/A $31
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $69 N/A $26
Group Psychotherapy $182 Near Average
State Average: 4
 $69
Hepatic (Liver) Function Panel $81 N/A $31
Hepatitis A Vaccine for Adults, Injected into Muscle $217 N/A $82
Hepatitis A Vaccine for Children, Injected into Muscle $271 N/A $103
Hepatitis B Surface Antibody Level $92 N/A $35
Hepatitis C Antibody Level $145 N/A $55
High Complexity Physical Therapy Evaluation $263 Near Average
State Average: 1
 $100
Human Papilloma Virus Vaccine, Injected into Muscle $66 N/A $25
Influenza Vaccine, Injected into Muscle $112 N/A $42
Injection of Substance for Pain Management, Lower Back or Tailbone $2,849 N/A $1,083
Iron Binding Capacity $53 N/A $20
Iron Level $42 N/A $16
Knee MRI $348 N/A $132
Lab Test to Detect HIV-1 and HIV-2 $146 N/A $55
Lab Test to Measure Creatinine Level $119 N/A $45
Lead Level $118 N/A $45
Low Back MRI, Before and After Contrast $3,142 N/A $1,194
Low Complexity Physical Therapy Evaluation $126 Near Average
State Average: 1
 $48
Manual Physical Therapy $47 Below Average
State Average: 4
 $18
Microalbumin (Protein) Level $129 N/A $49
Moderate Complexity Physical Therapy Evaluation $147 Near Average
State Average: 1
 $56
Natriuretic Peptide Level $285 N/A $108
Neuromuscular Reeducation $47 Below Average
State Average: 4
 $18
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $641 N/A $243
New Patient Preventive Care Visit for Adult, 40-64 $665 N/A $253
New Patient Preventive Care Visit for Adult, Ages 18-39 $641 N/A $243
New Patient Preventive Care Visit for Child, Ages 5-11 $260 N/A $99
New Patient Preventive Care Visit for Child, Under Age 1 $378 N/A $144
Office Visit for Established Patient, Basic $225 N/A $85
Office Visit for Established Patient, High Complexity $663 N/A $252
Office Visit for Established Patient, Low Complexity $312 N/A $119
Office Visit for Established Patient, Minimal Presenting Problem $135 N/A $51
Office Visit for Established Patient, Moderate Complexity $480 N/A $182
Office Visit for New Patient, High Complexity $865 N/A $329
Office Visit for New Patient, Low Complexity $468 N/A $178
Office Visit for New Patient, Minor Complexity $222 N/A $84
Office Visit for New Patient, Moderate Complexity $753 N/A $286
Pap Test Screening, Automated with Manual Review $250 N/A $95
Pelvis MRI $6,169 N/A $2,344
Physical Therapy Re-Evaluation $131 Near Average
State Average: 1
 $50
Pneumococcal Vaccine for Children, Injected into Muscle $111 N/A $42
Pregnancy Test $22 N/A $8
Preventive Care Visit for Adolescent, Under Ages 12-17 $254 N/A $97
Preventive Care Visit for Adult, 40-64 $596 N/A $227
Preventive Care Visit for Adult, Ages 18-39 $513 N/A $195
Preventive Care Visit for Child, Under Age 1 $223 N/A $85
Preventive Care Visit for Child, Under Ages 1-4 $231 N/A $88
Preventive Care Visit for Child, Under Ages 5-11 $230 N/A $87
Prostate Specific Antigen (PSA) Level, Total $108 N/A $41
Psychiatric Diagnostic Evaluation $200 Near Average
State Average: 1
 $76
Psychotherapy, 30 Minutes with Patient $112 Near Average
State Average: 1
 $43
Psychotherapy, 45 Minutes with Patient $150 Below Average
State Average: 3
 $57
Psychotherapy, 60 Minutes with Patient $168 Near Average
State Average: 6
 $64
Rotovirus Vaccine, Oral Administration $151 N/A $57
Screening Mammogram of Both Breasts $700 N/A $266
Self-Care or Home Management Training $63 Below Average
State Average: 2
 $24
Single-Level Injection for Pain Management, Lower Back or Tailbone $3,637 N/A $1,382
Skin Growth Removal, Premalignant or Precancerous $937 N/A $356
Skin Growth Removal, Up to 14, Benign or Noncancerous $884 N/A $336
Sleep Monitoring $5,625 N/A $2,137
Telehealth Visit for Established Patient, 11-20 minutes $205 N/A $78
Telehealth Visit for Established Patient, 21-30 minutes $298 N/A $113
Telehealth Visit for Established Patient, 5-10 minutes $53 N/A $20
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $66 N/A $25
Therapeutic Activities $95 Below Average
State Average: 3
 $36
Therapeutic Exercises $47 Below Average
State Average: 4
 $18
Thyroid Stimulating Hormone (TSH) Level $250 N/A $95
Transvaginal Ultrasound (Non-Maternity) $1,641 N/A $623
Ultrasound of Breast $110 N/A $42
Ultrasound of Heart (Echocardiogram) $4,041 N/A $1,536
Ultrasound of Pelvis $826 N/A $314
Urinalysis, Automated with Microscope Examination $162 N/A $61
Urinalysis, Manual Test $7 N/A $3
Vitamin B-12 (Cyanocobalamin) Level $88 N/A $34
Vitamin D-3 Level $171 N/A $65
X-Ray of Chest, 1 View $380 N/A $144
X-Ray of Chest, 2 Views $347 N/A $132
X-Ray of Fingers, 2 Views $209 N/A $79
X-Ray of Hand, 2 Views $552 N/A $210
X-Ray of Knee, 1 or 2 Views $294 N/A $112
X-Ray of Knee, 4 Views $335 N/A $127
X-Ray of Low Back, 4 Views $42 N/A $16
X-Ray of Lower Leg, 2 Views $78 N/A $30
X-Ray of Neck, 4 to 5 Views $515 N/A $196