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 $715 N/A $272
Automated Pap Test Screening and Manual Rescreening $261 N/A $99
Automated with Microscope Examination $156 N/A $59
Automated without Microscope $104 N/A $40
Back MRI $3,815 N/A $1,450
Bacterial Culture Swab $89 N/A $34
Bacterial Culture Swab for Aerobic Isolates $83 N/A $32
Bacterial Culture, Quantitative Colony Count $131 N/A $50
Basic Metabolic Panel $82 N/A $31
Blood Count (Hemoglobin) $44 N/A $17
Blood Glucose (Sugar) Level $29 N/A $11
Blood Glucose Control (Hemoglobin A1C) $58 N/A $22
Blood Typing (ABO) $48 N/A $18
Blood Typing (Rh (D)) $16 N/A $6
Bone Density Scan $33 N/A $12
Borrelia Burgdorferi (Lyme disease) Antibody Level $139 N/A $53
Brain MRI $7,854 N/A $2,985
C-reactive Protein (CRP) Level $72 N/A $28
Chlamydia Test $237 N/A $90
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 $71 N/A $27
Comprehensive Metabolic Panel $97 N/A $37
Creatinine Level $30 N/A $12
CT Scan of Abdomen and Pelvis, With Contrast $4,708 N/A $1,789
CT Scan of Chest, With Contrast $3,300 N/A $1,254
Detection for Strep (Streptococcus, group A) $28 N/A $11
Detection Test for Hepatitis B Surface Antigen $119 N/A $45
Detection Test for Human Papillomavirus (HPV) $300 N/A $114
Diagnostic Mammogram of Both Breasts $1,347 N/A $512
Diagnostic Mammogram of One Breast $807 N/A $307
Electrocardiogram (ECG or EKG) With Report and Interpretation $526 N/A $200
Electrocardiogram (ECG or EKG) With Tracing $637 N/A $242
Electrocardiogram (ECG or EKG), Report and Interpretation Only $126 N/A $48
Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) $135 N/A $51
Family Psychotherapy with Patient $141 Above Average
State Average: 2
$53
Ferritin (Blood Protein) Level $161 N/A $61
Follow-Up Pregnancy Ultrasound $950 N/A $361
General Health Panel $269 N/A $102
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $256 N/A $97
Group Psychotherapy $140 Near Average
State Average: 4
$53
Hepatic (Liver) Function Panel $49 N/A $19
Hepatitis C Antibody Level $108 N/A $41
Influenza Vaccine, Injected into Muscle $62 N/A $24
Iron Binding Capacity $77 N/A $29
Iron Level $51 N/A $19
Knee MRI $3,033 N/A $1,152
Lab Test to Detect Coronavirus (COVID-19) $107 N/A $41
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 Measure Creatinine Level $175 N/A $67
LDL Cholesterol Level $36 N/A $14
Lead Level $90 N/A $34
Lipase (Fat Enzyme) Level $41 N/A $16
Liver Enzyme (ALT or SGPT) Level $47 N/A $18
Low Complexity Physical Therapy Evaluation $299 Near Average
State Average: 1
$114
Magnesium Level $40 N/A $15
Manual Pap Test Screening $58 N/A $22
Manual Physical Therapy $159 Below Average
State Average: 4
$60
Microalbumin (Protein) Level $190 N/A $72
Moderate Complexity Physical Therapy Evaluation $324 Near Average
State Average: 1
$123
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $480 N/A $182
New Patient Preventive Care Visit for Adult, 40-64 $559 N/A $212
New Patient Preventive Care Visit for Adult, Ages 18-39 $480 N/A $182
Office Visit for Established Patient, Basic $171 N/A $65
Office Visit for Established Patient, High Complexity $522 N/A $198
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 $451 N/A $172
Office Visit for New Patient, Low Complexity $163 N/A $62
Office Visit for New Patient, Minor Complexity $275 N/A $105
Office Visit for New Patient, Moderate Complexity $349 N/A $132
Parathyroid Hormone (PTH) Level $63 N/A $24
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $118
Pneumococcal Conjugate Vaccine, Injected into Muscle $720 N/A $273
Pregnancy Test $32 N/A $12
Presence of Drug $362 N/A $138
Preventive Care Visit for Adolescent, Under Ages 12-17 $210 N/A $80
Preventive Care Visit for Adult, 40-64 $457 N/A $174
Preventive Care Visit for Adult, Ages 18-39 $419 N/A $159
Preventive Care Visit for Child, Under Age 1 $316 N/A $120
Preventive Care Visit for Child, Under Ages 1-4 $339 N/A $129
Preventive Care Visit for Child, Under Ages 5-11 $339 N/A $129
Prostate Specific Antigen (PSA) Level $108 N/A $41
Psychiatric Diagnostic Evaluation $186 Near Average
State Average: 1
$71
Psychotherapy, 30 Minutes with Patient $174 Above Average
State Average: 1
$66
Psychotherapy, 45 Minutes with Patient $194 Below Average
State Average: 4
$74
Psychotherapy, 60 Minutes with Patient $137 Below Average
State Average: 6
$52
Punch Biopsy of Skin $1,955 N/A $743
Screening Mammogram of Both Breasts $1,156 N/A $439
Self-Care or Home Management Training $57 Near Average
State Average: 2
$22
Skin Growth Removal, Premalignant or Precancerous $597 N/A $227
Skin Growth Removal, Up to 14, Benign or Noncancerous $624 N/A $237
Tangential Biopsy of Skin $1,437 N/A $546
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $166 N/A $63
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $144 N/A $55
Therapeutic Exercises $143 Near Average
State Average: 4
$54
Thyroglobulin (Thyroid Protein) Antibody Level $170 N/A $65
Thyroid Stimulating Hormone (TSH) Level $101 N/A $38
Thyroxine (Thyroid Chemical) Level, Free $54 N/A $20
Total Protein Level $185 N/A $70
Transvaginal Ultrasound (Non-Maternity) $683 N/A $259
Ultrasound of Breast $491 N/A $187
Ultrasound of Pelvis $620 N/A $235
Urinalysis, Manual Test $32 N/A $12
Vitamin D-3 Level $120 N/A $45
X-Ray of Chest, 1 View $20,166 N/A $7,663
X-Ray of Chest, 2 Views $622 N/A $236
X-Ray of Spine, 4 Views $637 N/A $242
X-Ray of Wrist $463 N/A $176