Dartmouth-Hitchcock (Keene)

580-590 Court Street Keene, NH 03431
http://www.dartmouth-hitchcock.org/index.html
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Radiology Services

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Bone Density Scan (outpatient)$6150%$615 Medium
Mammogram (outpatient)$10120%$1012 Medium
Ultrasound - Pregnancy (outpatient)$6430%$643 Medium
Ultrasound - Transvaginal (non-maternity)$6570%$657 Low
Urine Capacity Measurement$4590%$459 Medium
X-Ray - Knee (outpatient)$9020%$902 Medium

Outpatient Tests and Procedures

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Arthrocentesis (outpatient)$8720%$872 Medium
Biopsy, Skin lesion$12940%$1294 Medium
Destruction of Lesion (outpatient)$5490%$549 Medium
Destruction of lesions, up to 14$6300%$630 Medium
Diagnostic Laryngoscopy$10570%$1057 Medium
Nasal endoscopy, diagnostic$12980%$1298 Medium

Laboratory Services

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Blood test for basic metabolic panel$1600%$160 Medium
Blood test for clotting time$620%$62 Medium
Blood test for complete blood cell count and automated WBC$930%$93 Medium
Blood test for complete blood cell count (hemoglobin)$390%$39 Medium
Blood test for PSA (prostate specific antigen) level$1600%$160 Medium
Blood test for thyroxine (thyroid chemical) level, free$730%$73 Medium
Blood test for TSH (thyroid stimulating hormone) level$1640%$164 Medium
Chlamydia test$1060%$106 Medium
Gonorrhoeae test (Neisseria gonorrhoeae bacteria)$1580%$158 Medium
Health Screening - General Health Panel$1720%$172 Medium
Lipid Panel - Cholesterol Test$1350%$135 Medium
Metabolic Panel - Comprehensive$1290%$129 Medium
Pregnancy test, urine$560%$56 Medium
Test for disease-causing (pathogenic) organisms, not limited to a specific condition$560%$56 Medium
Strep Test (Streptococcus, group A)$920%$92 Medium
Test for vitamin D-3 level$2330%$233 Medium
Urinalysis test automated without microscope$250%$25 Medium

Office Visits

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Basic Office Visit$1450%$145 Medium
Office Visit, Established Pt$2030%$203 Medium
Office Visit of Moderate Complexity$3100%$310 Medium
Office Visit of Moderate to High Complexity$4420%$442 Medium
Office Visit, New Pt, Minor$2340%$234 Medium
Office Visit, New Pt, Low$3100%$310 Medium
Comp Preventive Medicine younger than 1 yrs old$2580%$258 Medium
Comp Preventive Medicine 1-4 yrs old$2810%$281 Medium
Comp Preventive Medicine 5-11 yrs old$2770%$277 Medium
Comp Preventive Medicine 12-17 yrs old$3320%$332 Medium
Comp Preventive Medicine 18-39 yrs old$3620%$362 Medium
Comp Preventive Medicine 40-64 yrs old$3950%$395 Medium
New Patient, Comp Prevent Medicine younger than 1 yrs old$3300%$330 Medium
New Patient, Comp Prevent Medicine 1-4 yrs old$3580%$358 Medium
New Patient, Comp Prevent Medicine 5-11 yrs old$3660%$366 Medium
New Patient, Comp Prevent Medicine 12-17 yrs old$4200%$420 Medium
New Patient, Comp Prevent Medicine 18-39 yrs old$4140%$414 Medium
New Patient, Comp Prevent Medicine 40-64 yrs old$4670%$467 Medium