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: 0%
Arthrocentesis $823 N/A $823
Automated Pap Test Screening and Manual Rescreening $246 N/A $246
Automated with Microscope Examination $156 N/A $156
Automated without Microscope $104 N/A $104
Back MRI $3,672 N/A $3,672
Bacterial Culture $31 N/A $31
Bacterial Culture Swab for Aerobic Isolates $105 N/A $105
Bacterial Culture, Quantitative Colony Count $90 N/A $90
Basic Metabolic Panel $50 N/A $50
Blood Count (Hemoglobin) $26 N/A $26
Blood Glucose (Sugar) Level $23 N/A $23
Blood Glucose Control (Hemoglobin A1C) $102 N/A $102
Blood Typing (Rh (D)) $16 N/A $16
Bone Density Scan $608 N/A $608
Borrelia Burgdorferi (Lyme disease) Antibody Level $139 N/A $139
Brain MRI $7,296 N/A $7,296
C-reactive Protein (CRP) Level $112 N/A $112
Chlamydia Test $81 N/A $81
Cholesterol Test, Lipid Panel $107 N/A $107
Clotting Time $79 N/A $79
Complete Blood Cell Count (Hemoglobin) $56 N/A $56
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
Creatinine Level $30 N/A $30
CT Scan of Abdomen and Pelvis, With Contrast $4,884 N/A $4,884
CT Scan of Chest, With Contrast $3,381 N/A $3,381
Detection for Strep (Streptococcus, group A) $107 N/A $107
Detection Test for Human Papillomavirus (HPV) $300 N/A $300
Electrocardiogram (ECG or EKG) With Report and Interpretation $465 N/A $465
Electrocardiogram (ECG or EKG) With Tracing $612 N/A $612
Electrocardiogram (ECG or EKG), Report and Interpretation Only $126 N/A $126
Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) $155 N/A $155
Family Psychotherapy with Patient $135 Below Average
State Average: 3
$135
Ferritin (Blood Protein) Level $157 N/A $157
Follow-Up Pregnancy Ultrasound $956 N/A $956
General Health Panel $212 N/A $212
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $81 N/A $81
Group Psychotherapy $134 Below Average
State Average: 5
$134
Hepatitis B Surface Antibody Level $91 N/A $91
Hepatitis C Antibody Level $176 N/A $176
Influenza Vaccine, Injected into Muscle $62 N/A $62
Iron Binding Capacity $96 N/A $96
Iron Level $60 N/A $60
Knee MRI $3,026 N/A $3,026
Lab Test to Detect Coronavirus (COVID-19) $105 N/A $105
Lab Test to Detect HIV-1 and HIV-2 $195 N/A $195
Lab Test to Detect Influenza Virus $88 N/A $88
Lab Test to Measure Creatinine Level $175 N/A $175
Lead Level $87 N/A $87
Manual Pap Test Screening $58 N/A $58
Manual Physical Therapy $159 Below Average
State Average: 4
$159
Microalbumin (Protein) Level $131 N/A $131
Moderate Complexity Physical Therapy Evaluation $317 Near Average
State Average: 1
$317
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $480 N/A $480
New Patient Preventive Care Visit for Adult, 40-64 $537 N/A $537
New Patient Preventive Care Visit for Adult, Ages 18-39 $460 N/A $460
New Patient Preventive Care Visit for Child, Under Age 1 $392 N/A $392
Office Visit for Established Patient, Basic $132 N/A $132
Office Visit for Established Patient, High Complexity $501 N/A $501
Office Visit for Established Patient, Low Complexity $246 N/A $246
Office Visit for Established Patient, Minimal Presenting Problem $107 N/A $107
Office Visit for Established Patient, Moderate Complexity $372 N/A $372
Office Visit for New Patient, High Complexity $451 N/A $451
Office Visit for New Patient, Low Complexity $163 N/A $163
Office Visit for New Patient, Minor Complexity $264 N/A $264
Office Visit for New Patient, Moderate Complexity $349 N/A $349
Pathology Examination of Tissue, Intermediate Complexity $375 N/A $375
Pelvis MRI $6,531 N/A $6,531
Pneumococcal Conjugate Vaccine, Injected into Muscle $654 N/A $654
Pregnancy Test $32 N/A $32
Pregnancy Ultrasound (Outpatient) $852 N/A $852
Presence of Drug $362 N/A $362
Preventive Care Visit for Adolescent, Under Ages 12-17 $403 N/A $403
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 $316 N/A $316
Preventive Care Visit for Child, Under Ages 1-4 $339 N/A $339
Preventive Care Visit for Child, Under Ages 5-11 $369 N/A $369
Prostate Specific Antigen (PSA) Level $108 N/A $108
Psychiatric Diagnostic Evaluation $200 Near Average
State Average: 1
$200
Psychotherapy, 30 Minutes with Patient $167 Above Average
State Average: 1
$167
Psychotherapy, 45 Minutes with Patient $172 Below Average
State Average: 4
$172
Psychotherapy, 60 Minutes with Patient $180 Below Average
State Average: 6
$180
Punch Biopsy of Skin $2,087 N/A $2,087
Screening Mammogram of Both Breasts $1,085 N/A $1,085
Skin Growth Removal, Premalignant or Precancerous $628 N/A $628
Skin Growth Removal, Up to 14, Benign or Noncancerous $693 N/A $693
Tangential Biopsy of Skin $1,463 N/A $1,463
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $144 N/A $144
Therapeutic Exercises $95 Near Average
State Average: 4
$95
Thyroglobulin (Thyroid Protein) Antibody Level $85 N/A $85
Thyroid Stimulating Hormone (TSH) Level $101 N/A $101
Thyroxine (Thyroid Chemical) Level, Free $138 N/A $138
Transvaginal Ultrasound (Non-Maternity) $683 N/A $683
Ultrasound of Breast $936 N/A $936
Ultrasound of Pelvis $692 N/A $692
Urinalysis, Manual Test $21 N/A $21
Vitamin D-3 Level $120 N/A $120
X-Ray of Chest, 2 Views $646 N/A $646
X-Ray of Wrist $548 N/A $548