Dartmouth-Hitchcock Medical Center

1 Medical Center Drive Lebanon, NH 03766
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
Mammogram (outpatient)$7320%$732 High
Ultrasound - Pelvic (outpatient)$6980%$698 Medium
Ultrasound - Pregnancy (outpatient)$5250%$525 Low
Ultrasound - Pregnancy follow-up$9560%$956 Medium
Ultrasound - Transvaginal (non-maternity)$7550%$755 Medium
X-Ray - Wrist (outpatient)$6180%$618 High

Outpatient Tests and Procedures

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Arthrocentesis (outpatient)$8480%$848 High
Destruction of Lesion (outpatient)$6520%$652 High

Laboratory Services

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Blood test for basic metabolic panel$480%$48 Medium
Blood test for blood glucose control (Hemoglobin A1C)$1180%$118 Medium
Blood test for clotting time$620%$62 Medium
Blood test for complete blood cell count and automated WBC$700%$70 Medium
Blood test for complete blood cell count (hemoglobin)$690%$69 Medium
Blood test for PSA (prostate specific antigen) level$1120%$112 Medium
Blood test for thyroxine (thyroid chemical) level, free$1200%$120 Medium
Blood test for TSH (thyroid stimulating hormone) level$950%$95 Medium
Chlamydia test$470%$47 Medium
Gonorrhoeae test (Neisseria gonorrhoeae bacteria)$1580%$158 Medium
Health Screening - General Health Panel$1780%$178 Medium
Hepatic (Liver) Function Panel$1310%$131 Medium
Lipid Panel - Cholesterol Test$950%$95 Medium
Urinalysis test automated with microscope examination$1770%$177 Medium
Metabolic Panel - Comprehensive$600%$60 Medium
Pap Test$1140%$114 Medium
Pregnancy test, urine$320%$32 Medium
Strep Test (Streptococcus, group A)$920%$92 Medium
Test for vitamin D-3 level$1770%$177 Medium
Urine test for bacterial culture$1010%$101 Medium

Office Visits

ProcedureEstimate of Total Cost Uninsured Discount What you Will Pay Typical Patient Complexity
Basic Office Visit$1310%$131 Medium
Office Visit, Established Pt$2030%$203 Medium
Office Visit of Moderate Complexity$2960%$296 Medium
Office Visit of Moderate to High Complexity$4280%$428 Medium
Office Visit, New Pt, Minor$2290%$229 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$3500%$350 Medium
Comp Preventive Medicine 18-39 yrs old$3500%$350 Medium
Comp Preventive Medicine 40-64 yrs old$3810%$381 Medium
New Patient, Comp Prevent Medicine younger than 1 yrs old$3300%$330 Medium
New Patient, Comp Prevent Medicine 1-4 yrs old$3680%$368 Medium
New Patient, Comp Prevent Medicine 5-11 yrs old$3680%$368 Medium
New Patient, Comp Prevent Medicine 12-17 yrs old$3990%$399 Medium
New Patient, Comp Prevent Medicine 18-39 yrs old$3990%$399 Medium
New Patient, Comp Prevent Medicine 40-64 yrs old$4650%$465 Medium