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 $753 N/A $753
Automated Pap Test Screening and Manual Rescreening $261 N/A $261
Automated with Microscope Examination $167 N/A $167
Automated without Microscope $17 N/A $17
Back MRI $3,539 N/A $3,539
Bacterial Culture Swab $194 N/A $194
Bacterial Culture, Quantitative Colony Count $123 N/A $123
Basic Metabolic Panel $109 N/A $109
Blood Count (Hemoglobin) $59 N/A $59
Blood Glucose (Sugar) Level $16 N/A $16
Blood Glucose Control (Hemoglobin A1C) $102 N/A $102
Blood Typing (ABO) $46 N/A $46
Blood Typing (Rh (D)) $69 N/A $69
Bone Density Scan $742 N/A $742
Borrelia Burgdorferi (Lyme disease) Antibody Level $139 N/A $139
Brain MRI $7,371 N/A $7,371
Chlamydia Test $207 N/A $207
Cholesterol Test, Lipid Panel $103 N/A $103
Clotting Time $53 N/A $53
Complete Blood Cell Count (Hemoglobin) $89 N/A $89
Complete Blood Cell Count and Automated White Blood Cells $71 N/A $71
Comprehensive Metabolic Panel $97 N/A $97
CT Scan of Abdomen and Pelvis, With Contrast $2,804 N/A $2,804
CT Scan of Chest, With Contrast $2,281 N/A $2,281
Detection for Strep (Streptococcus, group A) $108 N/A $108
Detection Test for Hepatitis B Surface Antigen $98 N/A $98
Detection Test for Human Papillomavirus (HPV) $275 N/A $275
Developmental Screening $70 N/A $70
Diagnostic Laryngoscopy $1,292 N/A $1,292
Electrocardiogram (ECG or EKG) With Report and Interpretation $909 N/A $909
Electrocardiogram (ECG or EKG) With Tracing $659 N/A $659
Electrocardiogram (ECG or EKG), Report and Interpretation Only $79 N/A $79
Ferritin (Blood Protein) Level $82 N/A $82
Follow-Up Pregnancy Ultrasound $510 N/A $510
General Health Panel $234 N/A $234
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $156 N/A $156
Group Psychotherapy $512 Below Average
State Average: 5
$512
Hepatitis C Antibody Level $185 N/A $185
Influenza Vaccine, Injected into Muscle $62 N/A $62
Iron Binding Capacity $53 N/A $53
Iron Level $39 N/A $39
Knee MRI $3,288 N/A $3,288
Lab Test to Detect Coronavirus (COVID-19) $107 N/A $107
Lab Test to Detect HIV-1 and HIV-2 $167 N/A $167
Lab Test to Detect Influenza Virus $35 N/A $35
Lab Test to Measure Creatinine Level $60 N/A $60
Lead Level $90 N/A $90
Lipase (Fat Enzyme) Level $41 N/A $41
Microalbumin (Protein) Level $77 N/A $77
Nasal Endoscopy $1,304 N/A $1,304
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $481 N/A $481
New Patient Preventive Care Visit for Adult, 40-64 $545 N/A $545
New Patient Preventive Care Visit for Adult, Ages 18-39 $480 N/A $480
New Patient Preventive Care Visit for Child, Ages 1-4 $406 N/A $406
New Patient Preventive Care Visit for Child, Ages 5-11 $427 N/A $427
New Patient Preventive Care Visit for Child, Under Age 1 $394 N/A $394
Office Visit for Established Patient, Basic $168 N/A $168
Office Visit for Established Patient, High Complexity $512 N/A $512
Office Visit for Established Patient, Low Complexity $235 N/A $235
Office Visit for Established Patient, Minimal Presenting Problem $107 N/A $107
Office Visit for Established Patient, Moderate Complexity $358 N/A $358
Office Visit for New Patient, High Complexity $424 N/A $424
Office Visit for New Patient, Low Complexity $305 N/A $305
Office Visit for New Patient, Minor Complexity $273 N/A $273
Office Visit for New Patient, Moderate Complexity $544 N/A $544
Pathology Examination of Tissue, Intermediate Complexity $375 N/A $375
Pelvis MRI $6,653 N/A $6,653
Pneumococcal Conjugate Vaccine, Injected into Muscle $654 N/A $654
Pregnancy Test $62 N/A $62
Pregnancy Ultrasound (Outpatient) $744 N/A $744
Presence of Drug $286 N/A $286
Preventive Care Visit for Adolescent, Under Ages 12-17 $387 N/A $387
Preventive Care Visit for Adult, 40-64 $461 N/A $461
Preventive Care Visit for Adult, Ages 18-39 $422 N/A $422
Preventive Care Visit for Child, Under Age 1 $302 N/A $302
Preventive Care Visit for Child, Under Ages 1-4 $324 N/A $324
Preventive Care Visit for Child, Under Ages 5-11 $324 N/A $324
Prostate Specific Antigen (PSA) Level $117 N/A $117
Punch Biopsy of Skin $1,344 N/A $1,344
Screening Mammogram of Both Breasts $547 N/A $547
Skin Growth Removal, Premalignant or Precancerous $526 N/A $526
Skin Growth Removal, Up to 14, Benign or Noncancerous $524 N/A $524
Tangential Biopsy of Skin $1,118 N/A $1,118
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $53 N/A $53
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $144 N/A $144
Therapeutic Exercises $62 Below Average
State Average: 4
$62
Thyroid Stimulating Hormone (TSH) Level $147 N/A $147
Thyroxine (Thyroid Chemical) Level, Free $116 N/A $116
Transvaginal Ultrasound (Non-Maternity) $599 N/A $599
Ultrasound of Breast $905 N/A $905
Ultrasound of Pelvis $595 N/A $595
Urinalysis, Manual Test $57 N/A $57
Vitamin D-3 Level $120 N/A $120
X-Ray of Chest, 2 Views $606 N/A $606
X-Ray of Foot $589 N/A $589
X-Ray of Knee $585 N/A $585
X-Ray of Shoulder $638 N/A $638