Mid-State Health Center

859 Lake Street Bristol, NH 03222
http://midstatehealth.org/
(603) 744-6200

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%
Blood Count (Hemoglobin) $5 N/A $5
Blood Glucose (Sugar) Level $26 N/A $26
Blood Glucose Control (Hemoglobin A1C) $34 N/A $34
Cholesterol Test, Lipid Panel $37 N/A $37
Clotting Time $21 N/A $21
Complete Blood Cell Count and Automated White Blood Cells $42 N/A $42
Detection for Strep (Streptococcus, group A) $40 N/A $40
Electrocardiogram (ECG or EKG) With Report and Interpretation $401 N/A $401
Electrocardiogram (ECG or EKG) With Tracing $240 N/A $240
Family Psychotherapy with Patient $214 Near Average
State Average: 3
 $214
Influenza Vaccine, Injected into Muscle $44 N/A $44
Lab Test to Detect Influenza Virus $40 N/A $40
Lead Level $25 N/A $25
New Patient Preventive Care Visit for Adolescent, Ages 12-17 $302 N/A $302
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
New Patient Preventive Care Visit for Child, Under Age 1 $246 N/A $246
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, Moderate Complexity $215 N/A $215
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
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
Prostate Specific Antigen (PSA) Level $190 N/A $190
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 Below Average
State Average: 4
 $182
Punch Biopsy of Skin $430 N/A $430
Screening Mammogram of Both Breasts $1,022 N/A $1,022
Skin Growth Removal, Premalignant or Precancerous $227 N/A $227
Tetanus, Diphtheria Toxoids, and Acellular Pertussis (Whooping Cough) Vaccine, Injected into Muscle $68 N/A $68
Urinalysis, Manual Test $18 N/A $18