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%
Arthrocentesis $618 N/A $235
Back MRI $243 N/A $92
Bacterial Culture $31 N/A $12
Bacterial Culture Swab $119 N/A $45
Bacterial Culture Swab for Aerobic Isolates $83 N/A $32
Bacterial Culture, Quantitative Colony Count $129 N/A $49
Basic Metabolic Panel $86 N/A $33
Biopsy of Skin Lesion $1,579 N/A $600
Blood Count (Hemoglobin) $36 N/A $14
Blood Glucose (Sugar) Level $30 N/A $11
Blood Glucose Control (Hemoglobin A1C) $58 N/A $22
Blood Typing (Rh (D)) $16 N/A $6
Bone Density Scan $33 N/A $12
Brain MRI $373 N/A $142
Chiropractic Treatment, 3-4 Spinal Regions $79 Below Average
State Average: 5
 $30
Chlamydia Test $179 N/A $68
Cholesterol Test, Lipid Panel $144 N/A $55
Clotting Time $79 N/A $30
Complete Blood Cell Count (Hemoglobin) $46 N/A $18
Complete Blood Cell Count and Automated White Blood Cells $76 N/A $29
Comprehensive Metabolic Panel $97 N/A $37
CT Scan of Abdomen and Pelvis, With Contrast $3,673 N/A $1,396
CT Scan of Chest, With Contrast $4,410 N/A $1,676
Detection for Strep (Streptococcus, group A) $118 N/A $45
Detection Test for Hepatitis B Surface Antigen $119 N/A $45
Detection Test for Human Papillomavirus (HPV) $384 N/A $146
Diagnostic Mammogram of Both Breasts $1,510 N/A $574
Diagnostic Mammogram of One Breast $835 N/A $317
Electrocardiogram (ECG or EKG) With Report and Interpretation $460 N/A $175
Electrocardiogram (ECG or EKG) With Tracing $637 N/A $242
Electrocardiogram (ECG or EKG), Report and Interpretation Only $131 N/A $50
Family Psychotherapy with Patient $116 Near Average
State Average: 2
 $44
Ferritin (Blood Protein) Level $121 N/A $46
Follow-Up Pregnancy Ultrasound $735 N/A $279
General Health Panel $273 N/A $104
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $116 N/A $44
Group Psychotherapy $146 Near Average
State Average: 4
 $55
Hepatic (Liver) Function Panel $79 N/A $30
Hepatitis A Vaccine for Adults, Injected into Muscle $197 N/A $75
Hepatitis A Vaccine for Children, Injected into Muscle $132 N/A $50
Hepatitis C Antibody Level $108 N/A $41
Influenza Vaccine, Injected into Muscle $97 N/A $37
Iron Binding Capacity $53 N/A $20
Iron Level $39 N/A $15
Knee MRI $221 N/A $84
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 $169 N/A $64
Lab Test to Detect Influenza Virus $42 N/A $16
Lab Test to Measure Creatinine Level $183 N/A $69
LDL Cholesterol Level $36 N/A $14
Lead Level $70 N/A $27
Lipase (Fat Enzyme) Level $44 N/A $17
Low Back MRI, Before and After Contrast $7,906 N/A $3,004
Low Complexity Physical Therapy Evaluation $311 Near Average
State Average: 1
 $118
Magnesium Level $40 N/A $15
Microalbumin (Protein) Level $142 N/A $54
Moderate Complexity Physical Therapy Evaluation $340 Near Average
State Average: 1
 $129
New Patient Preventive Care Visit for Adult, 40-64 $570 N/A $217
New Patient Preventive Care Visit for Adult, Ages 18-39 $501 N/A $190
New Patient Preventive Care Visit for Child, Under Age 1 $408 N/A $155
Office Visit for Established Patient, Basic $179 N/A $68
Office Visit for Established Patient, High Complexity $543 N/A $206
Office Visit for Established Patient, Low Complexity $261 N/A $99
Office Visit for Established Patient, Minimal Presenting Problem $112 N/A $43
Office Visit for Established Patient, Moderate Complexity $386 N/A $147
Office Visit for New Patient, High Complexity $743 N/A $282
Office Visit for New Patient, Low Complexity $168 N/A $64
Office Visit for New Patient, Minor Complexity $286 N/A $109
Office Visit for New Patient, Moderate Complexity $593 N/A $225
Pap Test Screening, Automated with Manual Review $261 N/A $99
Pap Test Screening, Manual $69 N/A $26
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $118
Pelvis MRI $7,610 N/A $2,892
Pregnancy Test $26 N/A $10
Preventive Care Visit for Adolescent, Under Ages 12-17 $405 N/A $154
Preventive Care Visit for Adult, 40-64 $457 N/A $174
Preventive Care Visit for Adult, Ages 18-39 $437 N/A $166
Preventive Care Visit for Child, Under Age 1 $316 N/A $120
Preventive Care Visit for Child, Under Ages 1-4 $245 N/A $93
Preventive Care Visit for Child, Under Ages 5-11 $315 N/A $120
Prostate Specific Antigen (PSA) Level, Total $108 N/A $41
Psychiatric Diagnostic Evaluation $179 Near Average
State Average: 1
 $68
Psychotherapy, 30 Minutes with Patient $179 Near Average
State Average: 1
 $68
Psychotherapy, 45 Minutes with Patient $194 Below Average
State Average: 4
 $74
Psychotherapy, 60 Minutes with Patient $158 Below Average
State Average: 6
 $60
Screening Mammogram of Both Breasts $223 N/A $85
Self-Care or Home Management Training $60 Above Average
State Average: 2
 $23
Skin Growth Removal, Premalignant or Precancerous $697 N/A $265
Skin Growth Removal, Up to 14, Benign or Noncancerous $726 N/A $276
Sleep Monitoring $5,022 N/A $1,908
Telehealth Visit for Established Patient, 11-20 minutes $183 N/A $69
Telehealth Visit for Established Patient, 21-30 minutes $244 N/A $93
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $166 N/A $63
Therapeutic Exercises $78 Near Average
State Average: 4
 $30
Thyroglobulin (Thyroid Protein) Antibody Level $170 N/A $65
Thyroid Stimulating Hormone (TSH) Level $101 N/A $38
Thyroxine (Thyroid Chemical) Level, Free $155 N/A $59
Transvaginal Ultrasound (Non-Maternity) $689 N/A $262
Ultrasound of Breast $791 N/A $300
Ultrasound of Heart (Echocardiogram) $4,500 N/A $1,710
Ultrasound of Pelvis $691 N/A $263
Urinalysis, Automated with Microscope Examination $165 N/A $63
Urinalysis, Automated without Microscope $110 N/A $42
Urinalysis, Manual Test $57 N/A $22
Urine Test with Examination $11 N/A $4
Vitamin D-3 Level $171 N/A $65
X-Ray of Chest, 1 View $872 N/A $331
X-Ray of Chest, 2 Views $627 N/A $238
X-Ray of Fingers, 2 Views $531 N/A $202
X-Ray of Hand, 2 Views $923 N/A $351
X-Ray of Knee, 1 or 2 Views $683 N/A $259
X-Ray of Knee, 4 Views $642 N/A $244
X-Ray of Low Back, 4 Views $42 N/A $16
X-Ray of Lower Leg, 2 Views $702 N/A $267
X-Ray of Neck, 4 to 5 Views $760 N/A $289
X-Ray of Shoulder, 2 Views $882 N/A $335
X-Ray of Wrist, 3 Views $603 N/A $229