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%
Antinuclear Antibodies (ANA) Level $53 N/A $20
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 $877 N/A $333
Back MRI $243 N/A $92
Bacterial Culture Swab for Aerobic Isolates $95 N/A $36
Bacterial Culture, Quantitative Colony Count $126 N/A $48
Basic Metabolic Panel $87 N/A $33
Biopsy of Skin Lesion $1,743 N/A $662
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) $26 N/A $10
Blood Typing (Rh (D)) $24 N/A $9
Bone Density Scan $33 N/A $12
Borrelia Burgdorferi (Lyme disease) Antibody Level $170 N/A $64
Brain MRI $6,351 N/A $2,414
C-reactive Protein (CRP) Level $77 N/A $29
Chiropractic Treatment, 3-4 Spinal Regions $79 Below Average
State Average: 5
 $30
Chlamydia Test $207 N/A $79
Cholesterol Test, Lipid Panel $166 N/A $63
Clotting Time $64 N/A $24
Coagulation Assessment $57 N/A $22
Complete Blood Cell Count (Hemoglobin) $108 N/A $41
Complete Blood Cell Count and Automated White Blood Cells $39 N/A $15
Comprehensive Eye Exam $152 N/A $58
Comprehensive Eye Exam, New Patient $179 N/A $68
Comprehensive Metabolic Panel $235 N/A $89
Creatinine Level $42 N/A $16
CT Scan of Abdomen and Pelvis, With Contrast $2,791 N/A $1,061
CT Scan of Chest, With Contrast $1,015 N/A $386
CT Scan of Pelvis, With Contrast $1,216 N/A $462
Detection for Strep (Streptococcus, group A) $26 N/A $10
Detection Test for Human Papillomavirus (HPV) $384 N/A $146
Developmental Screening $28 N/A $11
Diagnostic Imaging of Optic Nerve in Eye $158 N/A $60
Diagnostic Mammogram of Both Breasts $673 N/A $256
Diagnostic Mammogram of One Breast $565 N/A $215
Electrical Stimulation Therapy $53 Below Average
State Average: 3
 $20
Electrocardiogram (ECG or EKG) With Report and Interpretation $53 N/A $20
Electrocardiogram (ECG or EKG) With Tracing $150 N/A $57
Electrocardiogram (ECG or EKG), Report and Interpretation Only $147 N/A $56
Family Psychotherapy with Patient $105 Below Average
State Average: 2
 $40
Family Psychotherapy without Patient $147 Above Average
State Average: 1
 $56
Ferritin (Blood Protein) Level $161 N/A $61
Follow-Up Pregnancy Ultrasound $397 N/A $151
General Health Panel $248 N/A $94
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $204 N/A $77
Group Psychotherapy $166 Below Average
State Average: 5
 $63
Hepatic (Liver) Function Panel $81 N/A $31
Hepatitis A Vaccine for Adults, Injected into Muscle $205 N/A $78
Hepatitis A Vaccine for Children, Injected into Muscle $273 N/A $104
Hepatitis C Antibody Level $145 N/A $55
High Complexity Physical Therapy Evaluation $158 Near Average
State Average: 1
 $60
Human Papilloma Virus Vaccine, Injected into Muscle $66 N/A $25
Influenza Vaccine, Injected into Muscle $101 N/A $38
Injection of Substance for Pain Management, Lower Back or Tailbone $2,616 N/A $994
Iron Binding Capacity $101 N/A $38
Iron Level $63 N/A $24
Knee MRI $254 N/A $97
Lab Test to Detect Coronavirus (COVID-19) $158 N/A $60
Lab Test to Detect Coronavirus (COVID-19) Antigen $58 N/A $22
Lab Test to Detect HIV-1 and HIV-2 $139 N/A $53
Lab Test to Detect Influenza Virus $108 N/A $41
Lab Test to Measure Creatinine Level $183 N/A $69
Lead Level $108 N/A $41
Lipase (Fat Enzyme) Level $42 N/A $16
Low Back MRI, Before and After Contrast $373 N/A $142
Low Complexity Physical Therapy Evaluation $158 Near Average
State Average: 1
 $60
Magnesium Level $42 N/A $16
Manual Electrical Stimulation Therapy, 15 minutes $47 Near Average
State Average: 3
 $18
Manual Physical Therapy $47 Below Average
State Average: 4
 $18
Microalbumin (Protein) Level $142 N/A $54
Moderate Complexity Physical Therapy Evaluation $152 Near Average
State Average: 1
 $58
Natriuretic Peptide Level $141 N/A $53
Neuromuscular Reeducation $53 Below Average
State Average: 4
 $20
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $280 N/A $107
New Patient Preventive Care Visit for Adult, 40-64 $583 N/A $221
New Patient Preventive Care Visit for Adult, Ages 18-39 $501 N/A $190
New Patient Preventive Care Visit for Child, Ages 1-4 $239 N/A $91
New Patient Preventive Care Visit for Child, Ages 5-11 $242 N/A $92
New Patient Preventive Care Visit for Child, Under Age 1 $235 N/A $89
Office Visit for Established Patient, Basic $206 N/A $78
Office Visit for Established Patient, High Complexity $608 N/A $231
Office Visit for Established Patient, Low Complexity $286 N/A $109
Office Visit for Established Patient, Minimal Presenting Problem $124 N/A $47
Office Visit for Established Patient, Moderate Complexity $440 N/A $167
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 $286 N/A $109
Office Visit for New Patient, Moderate Complexity $691 N/A $263
Pap Test Screening, Automated with Manual Review $264 N/A $100
Pap Test Screening, Manual $69 N/A $26
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $118
Pelvis MRI $7,921 N/A $3,010
Physical Therapy Re-Evaluation $84 Near Average
State Average: 1
 $32
Pneumococcal Vaccine for Children, Injected into Muscle $151 N/A $57
Pregnancy Test $26 N/A $10
Pregnancy Ultrasound (Outpatient) $532 N/A $202
Presence of Drug $268 N/A $102
Preventive Care Visit for Adolescent, Under Ages 12-17 $254 N/A $97
Preventive Care Visit for Adult, 40-64 $501 N/A $190
Preventive Care Visit for Adult, Ages 18-39 $471 N/A $179
Preventive Care Visit for Child, Under Age 1 $223 N/A $85
Preventive Care Visit for Child, Under Ages 1-4 $223 N/A $85
Preventive Care Visit for Child, Under Ages 5-11 $223 N/A $85
Prostate Specific Antigen (PSA) Level, Total $108 N/A $41
Psychiatric Diagnostic Evaluation $221 Near Average
State Average: 1
 $84
Psychotherapy, 30 Minutes with Patient $112 Near Average
State Average: 1
 $43
Psychotherapy, 45 Minutes with Patient $150 Below Average
State Average: 4
 $57
Psychotherapy, 60 Minutes with Patient $158 Below Average
State Average: 6
 $60
Rotovirus Vaccine, Oral Administration $151 N/A $57
Screening Mammogram of Both Breasts $602 N/A $229
Self-Care or Home Management Training $53 Above Average
State Average: 2
 $20
Single-Level Injection for Pain Management, Lower Back or Tailbone $3,962 N/A $1,506
Skin Growth Removal, Premalignant or Precancerous $836 N/A $318
Skin Growth Removal, Up to 14, Benign or Noncancerous $810 N/A $308
Sleep Monitoring $3,134 N/A $1,191
Telehealth Visit for Established Patient, 11-20 minutes $194 N/A $74
Telehealth Visit for Established Patient, 21-30 minutes $273 N/A $104
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $83 N/A $32
Therapeutic Activities $79 Below Average
State Average: 3
 $30
Therapeutic Exercises $53 Near Average
State Average: 4
 $20
Thyroid Stimulating Hormone (TSH) Level $250 N/A $95
Thyroxine (Thyroid Chemical) Level, Free $104 N/A $40
Transvaginal Ultrasound (Non-Maternity) $454 N/A $172
Ultrasound of Breast $389 N/A $148
Ultrasound of Heart (Echocardiogram) $2,764 N/A $1,050
Ultrasound of Pelvis $456 N/A $173
Ultrasound Therapy $32 Below Average
State Average: 3
 $12
Urinalysis, Automated with Microscope Examination $63 N/A $24
Urinalysis, Automated without Microscope $47 N/A $18
Urinalysis, Manual Test $6 N/A $2
Urine Test with Examination $11 N/A $4
Vitamin B-12 (Cyanocobalamin) Level $156 N/A $59
Vitamin D-3 Level $197 N/A $75
Wound Repair, 2.5 Centimeters or Less $504 N/A $192
X-Ray of Chest, 1 View $329 N/A $125
X-Ray of Chest, 2 Views $318 N/A $121
X-Ray of Fingers, 2 Views $164 N/A $62
X-Ray of Hand, 2 Views $498 N/A $189
X-Ray of Knee, 1 or 2 Views $389 N/A $148
X-Ray of Knee, 4 Views $308 N/A $117
X-Ray of Low Back, 4 Views $42 N/A $16
X-Ray of Lower Leg, 2 Views $235 N/A $89
X-Ray of Neck, 4 to 5 Views $471 N/A $179