Ammonoosuc Community Health Services

25 Mount Eustis Road Littleton, NH 03561
http://www.ammonoosuc.org/
(603) 444-2464
Franconia, NH 03251
(603) 444-2464
Woodsville, NH 03785
(603) 444-2464
Whitefield, NH 03574
(603) 444-2464
Warren, NH 03238
(603) 444-2464

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 $429 N/A $429
Basic Metabolic Panel $152 N/A $152
Biopsy of Skin Lesion $512 N/A $512
Blood Count (Hemoglobin) $9 N/A $9
Blood Glucose Control (Hemoglobin A1C) $35 N/A $35
Cholesterol Test, Lipid Panel $152 N/A $152
Clotting Time $15 N/A $15
Complete Blood Cell Count (Hemoglobin) $76 N/A $76
Complete Blood Cell Count and Automated White Blood Cells $70 N/A $70
Comprehensive Metabolic Panel $173 N/A $173
Detection for Strep (Streptococcus, group A) $42 N/A $42
Detection Test for Human Papillomavirus (HPV) $180 N/A $180
Electrocardiogram (ECG or EKG) With Report and Interpretation $70 N/A $70
Family Psychotherapy with Patient $184 Above Average
State Average: 3
 $184
Folic Acid Level $152 N/A $152
Group Psychotherapy $192 Below Average
State Average: 4
 $192
Hepatitis A Vaccine for Adults, Injected into Muscle $171 N/A $171
Lead Level $51 N/A $51
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $292 N/A $292
New Patient Preventive Care Visit for Adult, 40-64 $350 N/A $350
New Patient Preventive Care Visit for Adult, Ages 18-39 $292 N/A $292
New Patient Preventive Care Visit for Child, Ages 5-11 $290 N/A $290
Office Visit for Established Patient, Basic $83 N/A $83
Office Visit for Established Patient, High Complexity $287 N/A $287
Office Visit for Established Patient, Low Complexity $146 N/A $146
Office Visit for Established Patient, Minimal Presenting Problem $45 N/A $45
Office Visit for Established Patient, Moderate Complexity $204 N/A $204
Office Visit for New Patient, High Complexity $368 N/A $368
Office Visit for New Patient, Low Complexity $207 N/A $207
Office Visit for New Patient, Minor Complexity $147 N/A $147
Office Visit for New Patient, Moderate Complexity $305 N/A $305
Pathology Examination of Tissue, Intermediate Complexity $21 N/A $21
Pregnancy Test $28 N/A $28
Preventive Care Visit for Adolescent, Under Ages 12-17 $239 N/A $239
Preventive Care Visit for Adult, 40-64 $261 N/A $261
Preventive Care Visit for Adult, Ages 18-39 $242 N/A $242
Preventive Care Visit for Child, Under Age 1 $252 N/A $252
Preventive Care Visit for Child, Under Ages 1-4 $217 N/A $217
Preventive Care Visit for Child, Under Ages 5-11 $217 N/A $217
Psychiatric Diagnostic Evaluation $189 Near Average
State Average: 1
 $189
Psychotherapy with Evaluation and Management, 45 Minutes with Patient $92 Near Average
State Average: 1
 $92
Psychotherapy, 30 Minutes with Patient $89 Above Average
State Average: 1
 $89
Psychotherapy, 45 Minutes with Patient $114 Below Average
State Average: 3
 $114
Psychotherapy, 60 Minutes with Patient $189 Below Average
State Average: 6
 $189
Screening Mammogram of Both Breasts $1,193 N/A $1,193
Skin Growth Removal, Premalignant or Precancerous $627 N/A $627
Thyroid Stimulating Hormone (TSH) Level $130 N/A $130
Thyroxine (Thyroid Chemical) Level, Free $125 N/A $125
Urinalysis, Manual Test $12 N/A $12
Vitamin B-12 (Cyanocobalamin) Level $152 N/A $152