Dartmouth-Hitchcock Medical Center

1 Medical Center Drive Lebanon, NH 03766
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Arthrocentesis (outpatient)$8190%$819
Bacterial Culture - Aerobic Isolates$1010%$101
Bacterial Culture - Swab$1870%$187
Biopsy - Punch Biopsy of Skin$2,1790%$2,179
Biopsy - Tangential Biopsy of Skin$1,4690%$1,469
Blood Test - Basic Metabolic Panel$480%$48
Blood Test - Blood Glucose Control (Hemoglobin A1C)$1090%$109
Blood Test - Cholesterol Test, Lipid Panel$950%$95
Blood Test - Clotting Time$620%$62
Blood Test - Coagulation Assessment$510%$51
Blood Test - Complete Blood Cell Count (Hemoglobin)$670%$67
Blood Test - Complete Blood Cell Count and Automated WBC$700%$70
Blood Test - Comprehensive Metabolic Panel$620%$62
Blood Test - Ferritin (Blood Protein) Level$780%$78
Blood Test - Folic Acid Level$1010%$101
Blood Test - General Health Panel$2120%$212
Blood Test - Hepatic (Liver) Function Panel$540%$54
Blood Test - Hepatitis C Antibody Level$2160%$216
Blood Test - Iron Level$280%$28
Blood Test - Lipase (fat enzyme) Level$300%$30
Blood Test - Prostate Specific Antigen (PSA) Level$1170%$117
Blood Test - Thyroid Stimulating Hormone (TSH) Level$950%$95
Blood Test - Thyroxine (Thyroid Chemical) Level, Free$1110%$111
Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement$850%$85
Blood Test - Vitamin B-12 (Cyanocobalamin) Level$970%$97
Blood Test - Vitamin D-3 Level$1860%$186
Bone Density Scan (outpatient)$7790%$779
Chiropractic Manipulative Treatment - Spinal, 1-2 Regions$480%$48
Chiropractic Manipulative Treatment - Spinal, 3-4 Regions$690%$69
CT Scan - Abdomen and Pelvis, with Contrast$2,7390%$2,739
CT Scan - Chest, with Contrast (outpatient)$3,0810%$3,081
Destruction of Lesion (outpatient)$5740%$574
Destruction of Lesions, up to 14$6810%$681
Detection test for Human Papillomavirus (HPV)$1880%$188
Electrocardiogram (ECG or EKG)$8690%$869
Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral)$1520%$152
Lab Test - Detection test for Hepatitis B Surface Antigen$1900%$190
Lab Test - Detection test for HIV-1 and HIV-2$1880%$188
Lab Test - Detection test for Influenza Virus$850%$85
Mammogram (outpatient)$1,0250%$1,025
MRI - Back (outpatient)$3,4680%$3,468
MRI - Brain (outpatient)$6,8200%$6,820
MRI - Knee (outpatient)$3,1400%$3,140
MRI - Pelvis (outpatient)$6,2950%$6,295
Office Visit - Basic$1580%$158
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old$4420%$442
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old$5160%$516
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old$4070%$407
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old$3760%$376
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old$3540%$354
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old$3870%$387
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old$3870%$387
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old$4220%$422
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old$3540%$354
Office Visit - Established Patient, High Complexity$4820%$482
Office Visit - Established Patient, Low Complexity$2260%$226
Office Visit - Established Patient, Moderate Complexity$3570%$357
Office Visit - New Patient, Low Complexity$1630%$163
Office Visit - New Patient, Minor$2530%$253
Office Visit - New Patient, Moderate Complexity$5200%$520
Pap Test$2360%$236
Physical Therapy - Moderate Complexity Evaluation$3090%$309
Physical Therapy - Therapeutic Exercises$1380%$138
Psychiatric Diagnostic Evaluation$2000%$200
Psychotherapy - 30 Minutes$1610%$161
Psychotherapy - 45 Minutes$1790%$179
Psychotherapy - 60 Minutes$1890%$189
Psychotherapy - Family Session$1350%$135
Psychotherapy - Group Session$1290%$129
Strep Test (Streptococcus, group A)$1030%$103
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition$1910%$191
Ultrasound - Breast (outpatient)$9220%$922
Ultrasound - Pelvic (outpatient)$6560%$656
Ultrasound - Pregnancy (outpatient)$8840%$884
Ultrasound - Pregnancy Follow-Up$9560%$956
Ultrasound - Transvaginal (non-maternity)$6830%$683
Urine Test - Automated with Microscope Examination$1710%$171
Urine Test - Automated without Microscope$1090%$109
Urine Test - Bacterial Culture, Quantitative Colony Count$900%$90
Urine Test - Chlamydia$1580%$158
Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria)$1580%$158
Urine Test - Microalbumin (Protein) Level$690%$69
Urine Test - Pregnancy$590%$59
Urine Test - Urinalysis, Manual Test$210%$21
Vaccine - Pneumococcal Conjugate for Injection into Muscle$6240%$624
Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle$1410%$141
X-Ray - Chest (outpatient)$5930%$593
X-Ray - Shoulder (outpatient)$8120%$812
X-Ray - Wrist (outpatient)$6900%$690