Dartmouth Health (Manchester)

100 Htichcock Way Manchester, NH 03104
https://www.dartmouth-health.org/
(603) 695-2500
58 Hawthorn Drive Bedford, NH 03110
(603) 695-2817

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 $826 N/A $826
Back MRI $4,933 N/A $4,933
Bacterial Culture $15 N/A $15
Bacterial Culture Swab for Aerobic Isolates $95 N/A $95
Bacterial Culture, Quantitative Colony Count $179 N/A $179
Biopsy of Skin Lesion $1,134 N/A $1,134
Blood Count (Hemoglobin) $51 N/A $51
Blood Glucose (Sugar) Level $35 N/A $35
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Blood Typing (ABO) $187 N/A $187
Blood Typing (Rh (D)) $231 N/A $231
Bone Density Scan $989 N/A $989
Brain MRI $9,662 N/A $9,662
Chlamydia Test $172 N/A $172
Cholesterol Test, Lipid Panel $159 N/A $159
Clotting Time $79 N/A $79
Complete Blood Cell Count (Hemoglobin) $53 N/A $53
Complete Blood Cell Count and Automated White Blood Cells $80 N/A $80
Comprehensive Eye Exam $315 N/A $315
Comprehensive Eye Exam, New Patient $368 N/A $368
Comprehensive Metabolic Panel $102 N/A $102
CT Scan of Abdomen and Pelvis, With Contrast $3,504 N/A $3,504
CT Scan of Chest, With Contrast $2,952 N/A $2,952
CT Scan of Pelvis, With Contrast $2,858 N/A $2,858
Detection for Strep (Streptococcus, group A) $131 N/A $131
Detection Test for Hepatitis B Surface Antigen $62 N/A $62
Detection Test for Human Papillomavirus (HPV) $190 N/A $190
Developmental Screening $98 N/A $98
Diagnostic Imaging of Optic Nerve in Eye $105 N/A $105
Diagnostic Laryngoscopy $1,737 N/A $1,737
Diagnostic Mammogram of Both Breasts $750 N/A $750
Diagnostic Mammogram of One Breast $616 N/A $616
Electrocardiogram (ECG or EKG) With Report and Interpretation $290 N/A $290
Electrocardiogram (ECG or EKG) With Tracing $172 N/A $172
Electrocardiogram (ECG or EKG), Report and Interpretation Only $118 N/A $118
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $36 N/A $36
Family Psychotherapy with Patient $226 Above Average
State Average: 3
 $226
Family Psychotherapy without Patient $226 Near Average
State Average: 1
 $226
Ferritin (Blood Protein) Level $82 N/A $82
Folic Acid Level $88 N/A $88
Follow-Up Pregnancy Ultrasound $294 N/A $294
General Health Panel $307 N/A $307
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $128 N/A $128
Group Psychotherapy $192 Above Average
State Average: 4
 $192
Hepatitis A Vaccine for Adults, Injected into Muscle $220 N/A $220
Hepatitis A Vaccine for Children, Injected into Muscle $479 N/A $479
Hepatitis C Antibody Level $168 N/A $168
Human Papilloma Virus Vaccine, Injected into Muscle $79 N/A $79
Influenza Vaccine, Injected into Muscle $112 N/A $112
Iron Binding Capacity $53 N/A $53
Iron Level $42 N/A $42
Knee MRI $4,583 N/A $4,583
Lab Test to Detect Coronavirus (COVID-19) Antigen $53 N/A $53
Lab Test to Detect HIV-1 and HIV-2 $153 N/A $153
Lab Test to Detect Influenza Virus $37 N/A $37
Nasal Endoscopy $1,682 N/A $1,682
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $641 N/A $641
New Patient Preventive Care Visit for Adult, 40-64 $326 N/A $326
New Patient Preventive Care Visit for Adult, Ages 18-39 $336 N/A $336
New Patient Preventive Care Visit for Child, Ages 1-4 $544 N/A $544
New Patient Preventive Care Visit for Child, Ages 5-11 $521 N/A $521
New Patient Preventive Care Visit for Child, Under Age 1 $521 N/A $521
Office Visit for Established Patient, Basic $142 N/A $142
Office Visit for Established Patient, High Complexity $663 N/A $663
Office Visit for Established Patient, Low Complexity $312 N/A $312
Office Visit for Established Patient, Minimal Presenting Problem $130 N/A $130
Office Visit for Established Patient, Moderate Complexity $480 N/A $480
Office Visit for New Patient, High Complexity $943 N/A $943
Office Visit for New Patient, Low Complexity $345 N/A $345
Office Visit for New Patient, Minor Complexity $147 N/A $147
Office Visit for New Patient, Moderate Complexity $753 N/A $753
Pap Test Screening, Automated with Manual Review $131 N/A $131
Parathyroid Hormone (PTH) Level $68 N/A $68
Pelvis MRI $8,634 N/A $8,634
Pneumococcal Vaccine for Children, Injected into Muscle $79 N/A $79
Pregnancy Test $22 N/A $22
Pregnancy Ultrasound (Outpatient) $389 N/A $389
Preventive Care Visit for Adolescent, Under Ages 12-17 $513 N/A $513
Preventive Care Visit for Adult, 40-64 $596 N/A $596
Preventive Care Visit for Adult, Ages 18-39 $513 N/A $513
Preventive Care Visit for Child, Under Age 1 $437 N/A $437
Preventive Care Visit for Child, Under Ages 1-4 $489 N/A $489
Preventive Care Visit for Child, Under Ages 5-11 $489 N/A $489
Prostate Cancer Screening $208 N/A $208
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 $184 Below Average
State Average: 3
 $184
Psychotherapy, 60 Minutes with Patient $263 Below Average
State Average: 6
 $263
Screening Mammogram of Both Breasts $773 N/A $773
Skin Growth Removal, Premalignant or Precancerous $666 N/A $666
Skin Growth Removal, Up to 14, Benign or Noncancerous $758 N/A $758
Sleep Monitoring $7,340 N/A $7,340
Telehealth Visit for Established Patient, 11-20 minutes $224 N/A $224
Telehealth Visit for Established Patient, 21-30 minutes $298 N/A $298
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $170 N/A $170
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $79 N/A $79
Therapeutic Exercises $16 Below Average
State Average: 4
 $16
Thyroid Stimulating Hormone (TSH) Level $115 N/A $115
Thyroxine (Thyroid Chemical) Level, Free $129 N/A $129
Transvaginal Ultrasound (Non-Maternity) $410 N/A $410
Ultrasound of Breast $496 N/A $496
Ultrasound of Heart (Echocardiogram) $2,459 N/A $2,459
Ultrasound of Pelvis $352 N/A $352
Urinalysis, Automated with Microscope Examination $55 N/A $55
Urinalysis, Automated without Microscope $21 N/A $21
Urinalysis, Manual Test $57 N/A $57
Urine Capacity Measurement $100 N/A $100
Vitamin B-12 (Cyanocobalamin) Level $88 N/A $88
Vitamin D-3 Level $225 N/A $225
X-Ray of Chest, 2 Views $347 N/A $347
X-Ray of Fingers, 2 Views $209 N/A $209
X-Ray of Foot, 2 Views $281 N/A $281
X-Ray of Foot, 3 Views $378 N/A $378
X-Ray of Hand, 2 Views $552 N/A $552
X-Ray of Knee, 1 or 2 Views $294 N/A $294
X-Ray of Knee, 4 Views $335 N/A $335
X-Ray of Lower Leg, 2 Views $298 N/A $298
X-Ray of Neck, 4 to 5 Views $515 N/A $515