Dartmouth-Hitchcock (Manchester)

100 Htichcock Way Manchester, NH 03104
Medical Procedures
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ProcedureEstimate of Total Cost Uninsured Discount What You Will Pay
Arthrocentesis (outpatient)$8480%$848
Bacterial Culture - Swab$1870%$187
Biopsy - Punch Biopsy of Skin$1,3090%$1,309
Biopsy - Tangential Biopsy of Skin$1,0680%$1,068
Blood Test - Basic Metabolic Panel$1090%$109
Blood Test - Blood Glucose Control (Hemoglobin A1C)$1090%$109
Blood Test - Cholesterol Test, Lipid Panel$950%$95
Blood Test - Clotting Time$620%$62
Blood Test - Complete Blood Cell Count (Hemoglobin)$780%$78
Blood Test - Complete Blood Cell Count and Automated WBC$700%$70
Blood Test - Comprehensive Metabolic Panel$540%$54
Blood Test - General Health Panel$1990%$199
Blood Test - Prostate Specific Antigen (PSA) Level$1120%$112
Blood Test - Thyroid Stimulating Hormone (TSH) Level$950%$95
Blood Test - Thyroxine (Thyroid Chemical) Level, Free$1110%$111
Blood Test - Vitamin D-3 Level$2870%$287
Bone Density Scan (outpatient)$6810%$681
CT Scan - Abdomen and Pelvis, with Contrast$2,6250%$2,625
CT Scan - Chest, with Contrast (outpatient)$2,1720%$2,172
Destruction of Lesion (outpatient)$5460%$546
Destruction of Lesions, up to 14$5850%$585
Detection test for Human Papillomavirus (HPV)$1950%$195
Electrocardiogram (ECG or EKG)$5510%$551
Lab Test - Detection test for HIV-1 and HIV-2$1140%$114
Lab Test - Detection test for Influenza Virus$350%$35
Laryngoscopy - Diagnostic$1,1790%$1,179
Mammogram (outpatient)$5230%$523
MRI - Back (outpatient)$3,3790%$3,379
MRI - Brain (outpatient)$7,0830%$7,083
MRI - Knee (outpatient)$3,1400%$3,140
MRI - Pelvis (outpatient)$6,3930%$6,393
Nasal Endoscopy - Diagnostic$1,2900%$1,290
Office Visit - Basic$1620%$162
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old$4060%$406
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old$4800%$480
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old$4610%$461
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old$5210%$521
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old$4080%$408
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old$3680%$368
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old$3100%$310
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old$3700%$370
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old$4030%$403
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old$4400%$440
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old$3100%$310
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old$2890%$289
Office Visit - Established Patient, High Complexity$4920%$492
Office Visit - Established Patient, Low Complexity$2260%$226
Office Visit - Established Patient, Moderate Complexity$3440%$344
Office Visit - New Patient, Low Complexity$3440%$344
Office Visit - New Patient, Minor$2600%$260
Office Visit - New Patient, Moderate Complexity$5200%$520
Pap Test$2360%$236
Strep Test (Streptococcus, group A)$1030%$103
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition$1170%$117
Ultrasound - Breast (outpatient)$8310%$831
Ultrasound - Pelvic (outpatient)$5950%$595
Ultrasound - Pregnancy (outpatient)$7160%$716
Ultrasound - Pregnancy Follow-Up$4900%$490
Ultrasound - Transvaginal (non-maternity)$5720%$572
Urine Test - Automated with Microscope Examination$1120%$112
Urine Test - Automated without Microscope$170%$17
Urine Test - Bacterial Culture, Quantitative Colony Count$870%$87
Urine Test - Chlamydia$1330%$133
Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria)$1330%$133
Urine Test - Microalbumin (Protein) Level$690%$69
Urine Test - Pregnancy$590%$59
Urine Test - Urinalysis, Manual Test$550%$55
Vaccine - Pneumococcal Conjugate for Injection into Muscle$6240%$624
Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle$1410%$141
X-Ray - Chest (outpatient)$5810%$581
X-Ray - Foot (outpatient)$6200%$620
X-Ray - Knee (outpatient)$4600%$460
X-Ray - Shoulder (outpatient)$6360%$636