Dartmouth Health (Manchester)

100 Htichcock Way Manchester, NH 03104
http://www.dartmouth-hitchcock.org/index.html
(603) 695-2500

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 $739 N/A $739
Back MRI $4,526 N/A $4,526
Bacterial Culture $23 N/A $23
Bacterial Culture Swab $132 N/A $132
Bacterial Culture, Quantitative Colony Count $140 N/A $140
Biopsy of Skin Lesion $1,246 N/A $1,246
Blood Count (Hemoglobin) $51 N/A $51
Blood Glucose (Sugar) Level $29 N/A $29
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Bone Density Scan $907 N/A $907
Brain MRI $8,865 N/A $8,865
Cholesterol Test, Lipid Panel $146 N/A $146
Clotting Time $79 N/A $79
Complete Blood Cell Count (Hemoglobin) $77 N/A $77
Complete Blood Cell Count and Automated White Blood Cells $33 N/A $33
Comprehensive Eye Exam $329 N/A $329
Comprehensive Eye Exam, New Patient $422 N/A $422
Comprehensive Metabolic Panel $121 N/A $121
CT Scan of Abdomen and Pelvis, With Contrast $3,215 N/A $3,215
CT Scan of Chest, With Contrast $2,708 N/A $2,708
Detection for Strep (Streptococcus, group A) $131 N/A $131
Detection Test for Human Papillomavirus (HPV) $188 N/A $188
Developmental Screening $89 N/A $89
Diagnostic Imaging of Optic Nerve in Eye $214 N/A $214
Diagnostic Laryngoscopy $1,580 N/A $1,580
Diagnostic Mammogram of Both Breasts $688 N/A $688
Diagnostic Mammogram of One Breast $565 N/A $565
Electrocardiogram (ECG or EKG) With Report and Interpretation $252 N/A $252
Electrocardiogram (ECG or EKG) With Tracing $150 N/A $150
Electrocardiogram (ECG or EKG), Report and Interpretation Only $102 N/A $102
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $36 N/A $36
Family Psychotherapy with Patient $226 Above Average
State Average: 2
 $226
Ferritin (Blood Protein) Level $103 N/A $103
Follow-Up Pregnancy Ultrasound $552 N/A $552
General Health Panel $307 N/A $307
Hepatitis A Vaccine for Adults, Injected into Muscle $202 N/A $202
Hepatitis A Vaccine for Children, Injected into Muscle $521 N/A $521
Hepatitis C Antibody Level $112 N/A $112
Human Papilloma Virus Vaccine, Injected into Muscle $71 N/A $71
Influenza Vaccine, Injected into Muscle $101 N/A $101
Iron Binding Capacity $90 N/A $90
Iron Level $61 N/A $61
Knee MRI $4,205 N/A $4,205
Lab Test to Detect Coronavirus (COVID-19) $158 N/A $158
Lab Test to Detect Coronavirus (COVID-19) Antigen $80 N/A $80
Lab Test to Detect Influenza Virus $35 N/A $35
Lead Level $108 N/A $108
Lipase (Fat Enzyme) Level $69 N/A $69
Magnesium Level $40 N/A $40
Nasal Endoscopy $1,431 N/A $1,431
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $588 N/A $588
New Patient Preventive Care Visit for Adult, 40-64 $431 N/A $431
New Patient Preventive Care Visit for Adult, Ages 18-39 $525 N/A $525
New Patient Preventive Care Visit for Child, Ages 1-4 $499 N/A $499
New Patient Preventive Care Visit for Child, Ages 5-11 $482 N/A $482
New Patient Preventive Care Visit for Child, Under Age 1 $478 N/A $478
Office Visit for Established Patient, Basic $206 N/A $206
Office Visit for Established Patient, High Complexity $608 N/A $608
Office Visit for Established Patient, Low Complexity $286 N/A $286
Office Visit for Established Patient, Minimal Presenting Problem $124 N/A $124
Office Visit for Established Patient, Moderate Complexity $440 N/A $440
Office Visit for New Patient, High Complexity $865 N/A $865
Office Visit for New Patient, Low Complexity $468 N/A $468
Office Visit for New Patient, Minor Complexity $299 N/A $299
Office Visit for New Patient, Moderate Complexity $691 N/A $691
Pap Test Screening, Automated with Manual Review $264 N/A $264
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $310
Pelvis MRI $7,921 N/A $7,921
Phosphate Level $39 N/A $39
Pneumococcal Vaccine for Children, Injected into Muscle $67 N/A $67
Pregnancy Test $62 N/A $62
Pregnancy Ultrasound (Outpatient) $811 N/A $811
Presence of Drug $214 N/A $214
Preventive Care Visit for Adolescent, Under Ages 12-17 $471 N/A $471
Preventive Care Visit for Adult, 40-64 $547 N/A $547
Preventive Care Visit for Adult, Ages 18-39 $471 N/A $471
Preventive Care Visit for Child, Under Age 1 $401 N/A $401
Preventive Care Visit for Child, Under Ages 1-4 $449 N/A $449
Preventive Care Visit for Child, Under Ages 5-11 $449 N/A $449
Prostate Cancer Screening $205 N/A $205
Prostate Specific Antigen (PSA) Level, Total $108 N/A $108
Psychiatric Diagnostic Evaluation $415 Near Average
State Average: 1
 $415
Psychotherapy, 30 Minutes with Patient $206 Near Average
State Average: 1
 $206
Psychotherapy, 45 Minutes with Patient $147 Below Average
State Average: 4
 $147
Psychotherapy, 60 Minutes with Patient $210 Below Average
State Average: 6
 $210
Screening Mammogram of Both Breasts $700 N/A $700
Skin Growth Removal, Premalignant or Precancerous $715 N/A $715
Skin Growth Removal, Up to 14, Benign or Noncancerous $786 N/A $786
Telehealth Visit for Established Patient, 11-20 minutes $205 N/A $205
Telehealth Visit for Established Patient, 21-30 minutes $273 N/A $273
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $166 N/A $166
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $71 N/A $71
Thyroid Stimulating Hormone (TSH) Level $101 N/A $101
Thyroxine (Thyroid Chemical) Level, Free $88 N/A $88
Transvaginal Ultrasound (Non-Maternity) $627 N/A $627
Ultrasound of Breast $455 N/A $455
Ultrasound of Heart (Echocardiogram) $2,256 N/A $2,256
Ultrasound of Pelvis $704 N/A $704
Urinalysis, Automated with Microscope Examination $162 N/A $162
Urinalysis, Automated without Microscope $17 N/A $17
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $145 N/A $145
Vitamin D-3 Level $276 N/A $276
X-Ray of Chest, 2 Views $318 N/A $318
X-Ray of Fingers, 2 Views $191 N/A $191
X-Ray of Foot, 3 Views $350 N/A $350
X-Ray of Hand, 2 Views $506 N/A $506
X-Ray of Knee, 1 or 2 Views $395 N/A $395
X-Ray of Knee, 4 Views $308 N/A $308
X-Ray of Low Back, 4 Views $442 N/A $442
X-Ray of Lower Leg, 2 Views $273 N/A $273
X-Ray of Neck, 4 to 5 Views $471 N/A $471