Mid-State Health Center

859 Lake Street Bristol, NH 03222
http://midstatehealth.org/
(603) 744-6200
101 Boulder Point Drive Plymouth, NH 03264
(603) 536-4000

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%
Biopsy of Skin Lesion $566 N/A $566
Blood Count (Hemoglobin) $5 N/A $5
Blood Glucose (Sugar) Level $11 N/A $11
Blood Glucose Control (Hemoglobin A1C) $34 N/A $34
Clotting Time $21 N/A $21
Creatinine Level $15 N/A $15
Detection for Strep (Streptococcus, group A) $40 N/A $40
Electrocardiogram (ECG or EKG) With Report and Interpretation $74 N/A $74
Electrocardiogram (ECG or EKG) With Tracing $37 N/A $37
Family Psychotherapy with Patient $214 Below Average
State Average: 2
 $214
Hepatitis A Vaccine for Adults, Injected into Muscle $151 N/A $151
Hepatitis A Vaccine for Children, Injected into Muscle $114 N/A $114
High Complexity Physical Therapy Evaluation $263 Near Average
State Average: 1
 $263
Influenza Vaccine, Injected into Muscle $88 N/A $88
Lab Test to Detect Coronavirus (COVID-19) $226 N/A $226
Lab Test to Detect Coronavirus (COVID-19) Antigen $105 N/A $105
Lab Test to Detect Influenza Virus $40 N/A $40
Lead Level $25 N/A $25
Low Complexity Physical Therapy Evaluation $276 Near Average
State Average: 1
 $276
Manual Physical Therapy $81 Below Average
State Average: 4
 $81
Moderate Complexity Physical Therapy Evaluation $276 Near Average
State Average: 1
 $276
Neuromuscular Reeducation $87 Above Average
State Average: 4
 $87
New Patient Preventive Care Visit for Adult, 40-64 $334 N/A $334
New Patient Preventive Care Visit for Adult, Ages 18-39 $302 N/A $302
New Patient Preventive Care Visit for Child, Ages 1-4 $265 N/A $265
New Patient Preventive Care Visit for Child, Ages 5-11 $265 N/A $265
Office Visit for Established Patient, Basic $89 N/A $89
Office Visit for Established Patient, High Complexity $289 N/A $289
Office Visit for Established Patient, Low Complexity $147 N/A $147
Office Visit for Established Patient, Minimal Presenting Problem $58 N/A $58
Office Visit for Established Patient, Moderate Complexity $215 N/A $215
Office Visit for New Patient, High Complexity $420 N/A $420
Office Visit for New Patient, Low Complexity $236 N/A $236
Office Visit for New Patient, Minor Complexity $168 N/A $168
Office Visit for New Patient, Moderate Complexity $352 N/A $352
Pneumococcal Vaccine for Children, Injected into Muscle $44 N/A $44
Pregnancy Test $26 N/A $26
Preventive Care Visit for Adolescent, Under Ages 12-17 $252 N/A $252
Preventive Care Visit for Adult, 40-64 $277 N/A $277
Preventive Care Visit for Adult, Ages 18-39 $258 N/A $258
Preventive Care Visit for Child, Under Age 1 $208 N/A $208
Preventive Care Visit for Child, Under Ages 1-4 $233 N/A $233
Preventive Care Visit for Child, Under Ages 5-11 $233 N/A $233
Psychiatric Diagnostic Evaluation $282 Near Average
State Average: 1
 $282
Psychotherapy, 30 Minutes with Patient $121 Above Average
State Average: 1
 $121
Psychotherapy, 45 Minutes with Patient $182 Near Average
State Average: 4
 $182
Psychotherapy, 60 Minutes with Patient $282 Below Average
State Average: 6
 $282
Self-Care or Home Management Training $89 Above Average
State Average: 2
 $89
Skin Growth Removal, Premalignant or Precancerous $364 N/A $364
Telehealth Visit for Established Patient, 11-20 minutes $107 N/A $107
Therapeutic Activities $89 Near Average
State Average: 3
 $89
Therapeutic Exercises $81 Below Average
State Average: 4
 $81
Ultrasound Therapy $81 Near Average
State Average: 3
 $81
Urea Nitrogen Level $11 N/A $11
Urinalysis, Manual Test $18 N/A $18
Urine Test with Examination $26 N/A $26
X-Ray of Fingers, 2 Views $89 N/A $89
X-Ray of Knee, 4 Views $120 N/A $120
X-Ray of Low Back, 4 Views $142 N/A $142
X-Ray of Lower Leg, 2 Views $91 N/A $91
X-Ray of Neck, 4 to 5 Views $142 N/A $142