Mass General Brigham

104 Endicott Street, Suite 101 Chelmsford, MA 01824
http://www.massgeneral.org/mgpo/
(978) 882-6600
30 Tuscan Blvd Salem, NH 03079
(857) 282-8100

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%
Antinuclear Antibodies (ANA) Level $63 N/A $63
Arthrocentesis $606 N/A $606
Bacterial Culture, Quantitative Colony Count $68 N/A $68
Blood Count (Hemoglobin) $19 N/A $19
Blood Glucose Control (Hemoglobin A1C) $38 N/A $38
C-reactive Protein (CRP) Level $71 N/A $71
Chlamydia Test $294 N/A $294
Cholesterol Test, Lipid Panel $192 N/A $192
Colonoscopy With Biopsy for Noncancerous Growth $5,532 N/A $5,532
Colonoscopy With Polyp Removal $5,687 N/A $5,687
Colonoscopy Without Biopsy for Encounter for Preventive Health Services $4,152 N/A $4,152
Complete Blood Cell Count (Hemoglobin) $100 N/A $100
Complete Blood Cell Count and Automated White Blood Cells $116 N/A $116
Comprehensive Metabolic Panel $151 N/A $151
Detection for Strep (Streptococcus, group A) $107 N/A $107
Detection Test for Hepatitis B Surface Antigen $149 N/A $149
Developmental Screening $68 N/A $68
Electrocardiogram (ECG or EKG) With Report and Interpretation $103 N/A $103
Ferritin (Blood Protein) Level $196 N/A $196
Follow-Up Pregnancy Ultrasound $380 N/A $380
General Health Panel $512 N/A $512
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $294 N/A $294
Hepatic (Liver) Function Panel $118 N/A $118
Hepatitis B Surface Antibody Level $155 N/A $155
Hepatitis C Antibody Level $197 N/A $197
Human Papilloma Virus Vaccine, Injected into Muscle $23 N/A $23
Injection of Substance for Pain Management, Lower Back or Tailbone $2,340 N/A $2,340
Lab Test to Detect Coronavirus (COVID-19) $263 N/A $263
Lab Test to Detect HIV-1 and HIV-2 $333 N/A $333
Lab Test to Detect Influenza Virus $96 N/A $96
Lab Test to Measure Creatinine Level $75 N/A $75
LDL Cholesterol Level $132 N/A $132
Lead Level $67 N/A $67
Liver Enzyme (ALT or SGPT) Level $76 N/A $76
Liver Enzyme (AST or SGOT) Level $75 N/A $75
Magnesium Level $98 N/A $98
Microalbumin (Protein) Level $82 N/A $82
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $617 N/A $617
New Patient Preventive Care Visit for Adult, 40-64 $672 N/A $672
New Patient Preventive Care Visit for Adult, Ages 18-39 $586 N/A $586
New Patient Preventive Care Visit for Child, Ages 1-4 $518 N/A $518
New Patient Preventive Care Visit for Child, Under Age 1 $389 N/A $389
Office Visit for Established Patient, Basic $196 N/A $196
Office Visit for Established Patient, High Complexity $625 N/A $625
Office Visit for Established Patient, Low Complexity $315 N/A $315
Office Visit for Established Patient, Minimal Presenting Problem $81 N/A $81
Office Visit for Established Patient, Moderate Complexity $443 N/A $443
Office Visit for New Patient, High Complexity $762 N/A $762
Office Visit for New Patient, Low Complexity $519 N/A $519
Office Visit for New Patient, Moderate Complexity $579 N/A $579
Parathyroid Hormone (PTH) Level $594 N/A $594
Pelvis MRI $2,963 N/A $2,963
Pregnancy Test $26 N/A $26
Pregnancy Ultrasound (Outpatient) $469 N/A $469
Preventive Care Visit for Adolescent, Under Ages 12-17 $393 N/A $393
Preventive Care Visit for Adult, 40-64 $559 N/A $559
Preventive Care Visit for Adult, Ages 18-39 $402 N/A $402
Preventive Care Visit for Child, Under Age 1 $394 N/A $394
Preventive Care Visit for Child, Under Ages 1-4 $360 N/A $360
Preventive Care Visit for Child, Under Ages 5-11 $359 N/A $359
Prostate Cancer Screening $265 N/A $265
Red Blood Cell Sedimentation Rate, Non-Automated $51 N/A $51
Telehealth Visit for Established Patient, 11-20 minutes $297 N/A $297
Telehealth Visit for Established Patient, 21-30 minutes $430 N/A $430
Telehealth Visit for Established Patient, 5-10 minutes $184 N/A $184
Thyroglobulin (Thyroid Protein) Antibody Level $87 N/A $87
Thyroid Stimulating Hormone (TSH) Level $243 N/A $243
Thyroxine (Thyroid Chemical) Level, Free $125 N/A $125
Urea Nitrogen Level $58 N/A $58
Urinalysis, Automated with Microscope Examination $45 N/A $45
Urinalysis, Automated without Microscope $7 N/A $7
Urinalysis, Manual Test $9 N/A $9
Vitamin B-12 (Cyanocobalamin) Level $82 N/A $82
Vitamin D-3 Level $428 N/A $428