Dartmouth-Hitchcock (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 $786 N/A $786
Back MRI $3,875 N/A $3,875
Bacterial Culture Swab $175 N/A $175
Bacterial Culture, Quantitative Colony Count $140 N/A $140
Basic Metabolic Panel $177 N/A $177
Biopsy of Skin Lesion $1,359 N/A $1,359
Blood Count (Hemoglobin) $51 N/A $51
Blood Glucose (Sugar) Level $23 N/A $23
Blood Glucose Control (Hemoglobin A1C) $58 N/A $58
Bone Density Scan $777 N/A $777
Brain MRI $7,589 N/A $7,589
C-reactive Protein (CRP) Level $37 N/A $37
Cholesterol Test, Lipid Panel $145 N/A $145
Clotting Time $79 N/A $79
Complete Blood Cell Count and Automated White Blood Cells $48 N/A $48
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 $2,752 N/A $2,752
CT Scan of Chest, With Contrast $2,318 N/A $2,318
Detection for Strep (Streptococcus, group A) $118 N/A $118
Detection Test for Human Papillomavirus (HPV) $280 N/A $280
Developmental Screening $77 N/A $77
Diagnostic Imaging of Optic Nerve in Eye $184 N/A $184
Diagnostic Laryngoscopy $1,367 N/A $1,367
Diagnostic Mammogram of Both Breasts $589 N/A $589
Diagnostic Mammogram of One Breast $484 N/A $484
Electrocardiogram (ECG or EKG) With Report and Interpretation $210 N/A $210
Electrocardiogram (ECG or EKG) With Tracing $125 N/A $125
Electrocardiogram (ECG or EKG), Report and Interpretation Only $85 N/A $85
Follow-Up Pregnancy Ultrasound $552 N/A $552
General Health Panel $273 N/A $273
Hepatitis A Vaccine for Adults, Injected into Muscle $202 N/A $202
Hepatitis A Vaccine for Children, Injected into Muscle $248 N/A $248
Hepatitis C Antibody Level $112 N/A $112
Human Papilloma Virus Vaccine, Injected into Muscle $67 N/A $67
Influenza Vaccine, Injected into Muscle $97 N/A $97
Knee MRI $3,600 N/A $3,600
Lab Test to Detect Coronavirus (COVID-19) $158 N/A $158
Lab Test to Detect Coronavirus (COVID-19) Antigen $53 N/A $53
Lab Test to Detect Influenza Virus $70 N/A $70
Lead Level $108 N/A $108
Lipase (Fat Enzyme) Level $144 N/A $144
Low Back MRI, Before and After Contrast $7,553 N/A $7,553
Magnesium Level $39 N/A $39
Nasal Endoscopy $1,422 N/A $1,422
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $525 N/A $525
New Patient Preventive Care Visit for Adult, 40-64 $593 N/A $593
New Patient Preventive Care Visit for Adult, Ages 18-39 $525 N/A $525
New Patient Preventive Care Visit for Child, Ages 5-11 $465 N/A $465
New Patient Preventive Care Visit for Child, Under Age 1 $422 N/A $422
Office Visit for Established Patient, Basic $184 N/A $184
Office Visit for Established Patient, High Complexity $557 N/A $557
Office Visit for Established Patient, Low Complexity $255 N/A $255
Office Visit for Established Patient, Minimal Presenting Problem $112 N/A $112
Office Visit for Established Patient, Moderate Complexity $393 N/A $393
Office Visit for New Patient, High Complexity $743 N/A $743
Office Visit for New Patient, Low Complexity $395 N/A $395
Office Visit for New Patient, Minor Complexity $299 N/A $299
Office Visit for New Patient, Moderate Complexity $595 N/A $595
Pap Test Screening, Automated with Manual Review $264 N/A $264
Pathology Examination of Tissue, Intermediate Complexity $310 N/A $310
Pelvis MRI $6,781 N/A $6,781
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 $523 N/A $523
Preventive Care Visit for Adolescent, Under Ages 12-17 $421 N/A $421
Preventive Care Visit for Adult, 40-64 $501 N/A $501
Preventive Care Visit for Adult, Ages 18-39 $460 N/A $460
Preventive Care Visit for Child, Under Age 1 $329 N/A $329
Preventive Care Visit for Child, Under Ages 1-4 $355 N/A $355
Preventive Care Visit for Child, Under Ages 5-11 $353 N/A $353
Prostate Cancer Screening $205 N/A $205
Prostate Specific Antigen (PSA) Level, Total $108 N/A $108
Psychiatric Diagnostic Evaluation $210 Near Average
State Average: 1
 $210
Psychotherapy, 30 Minutes with Patient $184 Near Average
State Average: 1
 $184
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 $602 N/A $602
Skin Growth Removal, Premalignant or Precancerous $702 N/A $702
Skin Growth Removal, Up to 14, Benign or Noncancerous $786 N/A $786
Sleep Monitoring $7,035 N/A $7,035
Telehealth Visit for Established Patient, 11-20 minutes $183 N/A $183
Telehealth Visit for Established Patient, 21-30 minutes $244 N/A $244
Telehealth Visit for Established Patient, 5-10 minutes $88 N/A $88
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $163 N/A $163
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $71 N/A $71
Thyroid Stimulating Hormone (TSH) Level $109 N/A $109
Transvaginal Ultrasound (Non-Maternity) $627 N/A $627
Ultrasound of Breast $389 N/A $389
Ultrasound of Heart (Echocardiogram) $1,932 N/A $1,932
Ultrasound of Pelvis $649 N/A $649
Urinalysis, Automated with Microscope Examination $165 N/A $165
Urinalysis, Automated without Microscope $17 N/A $17
Urinalysis, Manual Test $57 N/A $57
Vitamin B-12 (Cyanocobalamin) Level $111 N/A $111
X-Ray of Chest, 2 Views $272 N/A $272
X-Ray of Fingers, 2 Views $164 N/A $164
X-Ray of Foot, 3 Views $312 N/A $312
X-Ray of Hand, 2 Views $433 N/A $433
X-Ray of Knee, 1 or 2 Views $270 N/A $270
X-Ray of Knee, 4 Views $264 N/A $264
X-Ray of Low Back, 4 Views $411 N/A $411
X-Ray of Lower Leg, 2 Views $233 N/A $233
X-Ray of Neck, 4 to 5 Views $403 N/A $403