Upper Connecticut Valley Hospital

181 Corliss Lane Colebrook, NH 03576
http://www.ucvh.org/
(603) 237-4971

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: 41%
Antibody Screen, Red Blood Cells (RBC) $185 N/A $109
Antinuclear Antibodies (ANA) Level $101 N/A $59
Back MRI $3,262 N/A $1,925
Bacterial Culture Swab $72 N/A $43
Bacterial Culture Swab for Aerobic Isolates $68 N/A $40
Bacterial Culture, Quantitative Colony Count $68 N/A $40
Basic Metabolic Panel $92 N/A $55
Bilirubin Level $42 N/A $25
Blood Count (Hemoglobin) $20 N/A $12
Blood Glucose (Sugar) Level $28 N/A $16
Blood Glucose Control (Hemoglobin A1C) $90 N/A $53
Blood Typing (ABO) $25 N/A $15
Blood Typing (Rh (D)) $25 N/A $15
Bone Density Scan $637 N/A $376
Borrelia Burgdorferi (Lyme disease) Antibody Level $143 N/A $84
Brain MRI $3,938 N/A $2,323
C-reactive Protein (CRP) Level $92 N/A $55
Chlamydia Test $293 N/A $173
Cholesterol Test, Lipid Panel $146 N/A $86
Clotting Time $58 N/A $34
Coagulation Assessment $50 N/A $30
Colonoscopy With Biopsy for Noncancerous Growth $7,798 N/A $4,601
Colonoscopy With Polyp Removal $10,724 N/A $6,327
Complete Blood Cell Count (Hemoglobin) $66 N/A $39
Complete Blood Cell Count and Automated White Blood Cells $83 N/A $49
Comprehensive Metabolic Panel $116 N/A $68
Creatinine Level $43 N/A $25
CT Scan of Abdomen and Pelvis, With Contrast $4,043 N/A $2,385
Detection Test for Hepatitis B Surface Antigen $87 N/A $51
Detection Test for Human Papillomavirus (HPV) $293 N/A $173
Electrolytes Panel $77 N/A $45
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $72 N/A $43
Ferritin (Blood Protein) Level $166 N/A $98
Folic Acid Level $123 N/A $72
General Health Panel $379 N/A $224
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $293 N/A $173
Hepatic (Liver) Function Panel $89 N/A $53
Hepatitis B Core Antibody Level $145 N/A $85
Hepatitis B Surface Antibody Level $90 N/A $53
Hepatitis C Antibody Level $120 N/A $71
High Complexity Physical Therapy Evaluation $460 Near Average
State Average: 1
 $271
Hydration Infusion $383 N/A $226
Iron Binding Capacity $74 N/A $43
Iron Level $93 N/A $55
Knee MRI $3,131 N/A $1,847
Lab Test to Detect Coronavirus (COVID-19) $168 N/A $99
Lab Test to Detect HIV-1 and HIV-2 $210 N/A $124
Lab Test to Detect Influenza Virus $112 N/A $66
Lab Test to Measure Creatinine Level $44 N/A $26
LDL Cholesterol Level $80 N/A $47
Lead Level $102 N/A $60
Lipase (Fat Enzyme) Level $84 N/A $50
Liver Enzyme (ALT or SGPT) Level $45 N/A $27
Liver Enzyme (AST or SGOT) Level $44 N/A $26
Low Complexity (Outpatient) Emergency Department Visit $567 N/A $335
Low Complexity Physical Therapy Evaluation $361 Near Average
State Average: 1
 $213
Magnesium Level $78 N/A $46
Manual Electrical Stimulation Therapy, 15 minutes $76 Below Average
State Average: 3
 $45
Manual Physical Therapy $156 Below Average
State Average: 4
 $92
Microalbumin (Protein) Level $50 N/A $30
Minor (Outpatient) Emergency Department Visit $252 N/A $149
Moderate Complexity (Outpatient) Emergency Department Visit $882 N/A $520
Moderate Complexity Physical Therapy Evaluation $407 Near Average
State Average: 1
 $240
Natriuretic Peptide Level $284 N/A $167
New Patient Preventive Care Visit for Adult, 40-64 $263 N/A $155
New Patient Preventive Care Visit for Adult, Ages 18-39 $263 N/A $155
Office Visit for Established Patient, Basic $105 N/A $62
Office Visit for Established Patient, High Complexity $273 N/A $161
Office Visit for Established Patient, Low Complexity $147 N/A $87
Office Visit for Established Patient, Moderate Complexity $210 N/A $124
Office Visit for New Patient, Low Complexity $184 N/A $108
Office Visit for New Patient, Moderate Complexity $263 N/A $155
Pap Test Screening, Automated with Manual Review $231 N/A $136
Parathyroid Hormone (PTH) Level $344 N/A $203
Pathology Examination of Tissue, Intermediate Complexity $433 N/A $255
Phosphate Level $40 N/A $24
Pregnancy Test $59 N/A $35
Presence of Drug $486 N/A $287
Preventive Care Visit for Adolescent, Under Ages 12-17 $184 N/A $108
Preventive Care Visit for Adult, 40-64 $263 N/A $155
Preventive Care Visit for Adult, Ages 18-39 $263 N/A $155
Preventive Care Visit for Child, Under Ages 5-11 $184 N/A $108
Prostate Cancer Screening $154 N/A $91
Prostate Specific Antigen (PSA) Level, Free $154 N/A $91
Prostate Specific Antigen (PSA) Level, Total $154 N/A $91
Red Blood Cell Sedimentation Rate, Non-Automated $57 N/A $33
Renal (Kidney) Function Panel $95 N/A $56
Screening Mammogram of Both Breasts $1,118 N/A $660
Smear for Microorganism $41 N/A $24
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $56 N/A $33
Therapeutic Activities $167 Below Average
State Average: 3
 $99
Therapeutic Exercises $167 Below Average
State Average: 4
 $99
Thyroglobulin (Thyroid Protein) Antibody Level $133 N/A $79
Thyroid Stimulating Hormone (TSH) Level $181 N/A $107
Thyroxine (Thyroid Chemical) Level, Free $147 N/A $87
Total Protein Level $32 N/A $19
Transvaginal Ultrasound (Non-Maternity) $909 N/A $536
Treatment of Speech, Language, Voice, Communication, or Hearing Processing Disorder $369 N/A $217
Triiodothyronine (T3) Thyroid Hormone Measurement $142 N/A $84
Troponin (Protein) Analysis, Quantitative $175 N/A $103
Ultrasound of Abdomen, Complete $882 N/A $520
Ultrasound of Abdomen, Limited $734 N/A $433
Ultrasound of Breast $603 N/A $356
Ultrasound of Head and Neck $821 N/A $484
Ultrasound of Heart (Echocardiogram) $2,789 N/A $1,645
Ultrasound Therapy $127 Above Average
State Average: 3
 $75
Urea Nitrogen Level $28 N/A $16
Urinalysis, Automated with Microscope Examination $63 N/A $37
Urinalysis, Automated without Microscope $19 N/A $11
Urinalysis, Manual Test $5 N/A $3
Vitamin B-12 (Cyanocobalamin) Level $131 N/A $77
Vitamin D-3 Level $306 N/A $180
X-Ray of Abdomen, 1 View $328 N/A $193
X-Ray of Ankle, 3 Views $417 N/A $246
X-Ray of Chest, 2 Views $587 N/A $346
X-Ray of Foot, 3 Views $345 N/A $204
X-Ray of Hand, 3 Views $380 N/A $224
X-Ray of Hip, 2 or 3 Views $540 N/A $319
X-Ray of Knee, 3 Views $433 N/A $255
X-Ray of Knee, 4 Views $468 N/A $276
X-Ray of Low Back, 2 or 3 Views $412 N/A $243
X-Ray of Low Back, 4 Views $544 N/A $321
X-Ray of Neck, 2 or 3 Views $381 N/A $225
X-Ray of Shoulder, 2 Views $328 N/A $193
X-Ray of Wrist, 3 Views $433 N/A $255