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: 40%
Antinuclear Antibodies (ANA) Level $101 N/A $60
Back MRI $3,262 N/A $1,957
Bacterial Culture Swab $86 N/A $52
Bacterial Culture Swab for Aerobic Isolates $96 N/A $58
Bacterial Culture, Quantitative Colony Count $72 N/A $43
Basic Metabolic Panel $92 N/A $55
Bilirubin Level $42 N/A $25
Blood Count (Hemoglobin) $20 N/A $12
Blood Glucose (Sugar) Level $34 N/A $20
Blood Glucose Control (Hemoglobin A1C) $90 N/A $54
Blood Typing (ABO) $39 N/A $23
Blood Typing (Rh (D)) $129 N/A $77
Bone Density Scan $637 N/A $382
Borrelia Burgdorferi (Lyme disease) Antibody Level $143 N/A $86
C-reactive Protein (CRP) Level $55 N/A $33
Chlamydia Test $293 N/A $176
Cholesterol Test, Lipid Panel $146 N/A $88
Clotting Time $56 N/A $33
Coagulation Assessment $65 N/A $39
Complete Blood Cell Count (Hemoglobin) $66 N/A $40
Complete Blood Cell Count and Automated White Blood Cells $83 N/A $50
Comprehensive Metabolic Panel $116 N/A $69
Creatinine Level $49 N/A $30
CT Scan of Abdomen and Pelvis, With Contrast $4,695 N/A $2,817
Detection Test for Hepatitis B Surface Antigen $117 N/A $70
Detection Test for Human Papillomavirus (HPV) $350 N/A $210
Electrolytes Panel $77 N/A $46
Evaluation of Antimicrobial Drug (Antibiotic, Antifungal, Antiviral) $93 N/A $56
Ferritin (Blood Protein) Level $166 N/A $100
Folic Acid Level $138 N/A $83
General Health Panel $379 N/A $227
Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) Test $298 N/A $179
Hepatic (Liver) Function Panel $89 N/A $54
Hepatitis B Core Antibody Level $145 N/A $87
Hepatitis B Surface Antibody Level $107 N/A $64
Hepatitis C Antibody Level $162 N/A $97
High Complexity Physical Therapy Evaluation $435 Near Average
State Average: 1
 $261
Hydration Infusion $383 N/A $230
Iron Binding Capacity $90 N/A $54
Iron Level $103 N/A $62
Lab Test to Detect Coronavirus (COVID-19) $168 N/A $101
Lab Test to Detect HIV-1 and HIV-2 $210 N/A $126
Lab Test to Detect Influenza Virus $112 N/A $67
Lab Test to Measure Creatinine Level $44 N/A $26
LDL Cholesterol Level $85 N/A $51
Lead Level $108 N/A $65
Lipase (Fat Enzyme) Level $84 N/A $50
Liver Enzyme (ALT or SGPT) Level $50 N/A $30
Liver Enzyme (AST or SGOT) Level $49 N/A $30
Low Complexity (Outpatient) Emergency Department Visit $567 N/A $340
Low Complexity Physical Therapy Evaluation $361 Near Average
State Average: 1
 $217
Magnesium Level $78 N/A $47
Manual Electrical Stimulation Therapy, 15 minutes $76 Below Average
State Average: 3
 $45
Manual Physical Therapy $156 Below Average
State Average: 4
 $94
Microalbumin (Protein) Level $50 N/A $30
Minor (Outpatient) Emergency Department Visit $252 N/A $151
Moderate Complexity (Outpatient) Emergency Department Visit $779 N/A $467
Moderate Complexity Physical Therapy Evaluation $411 Near Average
State Average: 1
 $246
Natriuretic Peptide Level $315 N/A $189
New Patient Preventive Care Visit for Adult, 40-64 $263 N/A $158
New Patient Preventive Care Visit for Adult, Ages 18-39 $263 N/A $158
Office Visit for Established Patient, Basic $105 N/A $63
Office Visit for Established Patient, High Complexity $273 N/A $164
Office Visit for Established Patient, Low Complexity $147 N/A $88
Office Visit for Established Patient, Minimal Presenting Problem $76 N/A $45
Office Visit for Established Patient, Moderate Complexity $210 N/A $126
Office Visit for New Patient, Low Complexity $184 N/A $110
Office Visit for New Patient, Moderate Complexity $263 N/A $158
Pap Test Screening, Automated with Manual Review $231 N/A $139
Parathyroid Hormone (PTH) Level $399 N/A $239
Pathology Examination of Tissue, Intermediate Complexity $268 N/A $161
Phosphate Level $43 N/A $26
Pregnancy Test $59 N/A $35
Presence of Drug $486 N/A $292
Preventive Care Visit for Adolescent, Under Ages 12-17 $184 N/A $110
Preventive Care Visit for Adult, 40-64 $263 N/A $158
Preventive Care Visit for Adult, Ages 18-39 $263 N/A $158
Preventive Care Visit for Child, Under Ages 5-11 $184 N/A $110
Prostate Cancer Screening $154 N/A $93
Prostate Specific Antigen (PSA) Level, Free $154 N/A $93
Prostate Specific Antigen (PSA) Level, Total $154 N/A $93
Red Blood Cell Sedimentation Rate, Non-Automated $57 N/A $34
Renal (Kidney) Function Panel $95 N/A $57
Screening Mammogram of Both Breasts $1,118 N/A $671
Smear for Microorganism $47 N/A $28
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition $56 N/A $33
Therapeutic Activities $167 Below Average
State Average: 3
 $100
Therapeutic Exercises $167 Near Average
State Average: 4
 $100
Thyroglobulin (Thyroid Protein) Antibody Level $146 N/A $88
Thyroid Stimulating Hormone (TSH) Level $181 N/A $108
Thyroxine (Thyroid Chemical) Level, Free $147 N/A $88
Total Protein Level $32 N/A $19
Transvaginal Ultrasound (Non-Maternity) $1,203 N/A $722
Triiodothyronine (T3) Thyroid Hormone Measurement $142 N/A $85
Troponin (Protein) Analysis, Quantitative $175 N/A $105
Ultrasound of Abdomen, Complete $1,452 N/A $871
Ultrasound of Abdomen, Limited $806 N/A $484
Ultrasound of Breast $746 N/A $447
Ultrasound of Head and Neck $935 N/A $561
Ultrasound of Heart (Echocardiogram) $2,789 N/A $1,673
Ultrasound Therapy $127 Near Average
State Average: 3
 $76
Urea Nitrogen Level $37 N/A $22
Urinalysis, Automated with Microscope Examination $50 N/A $30
Urinalysis, Automated without Microscope $19 N/A $11
Urinalysis, Manual Test $5 N/A $3
Vitamin B-12 (Cyanocobalamin) Level $131 N/A $79
Vitamin D-3 Level $321 N/A $193
X-Ray of Chest, 2 Views $587 N/A $352
X-Ray of Foot, 3 Views $469 N/A $282
X-Ray of Hand, 3 Views $533 N/A $320
X-Ray of Hip, 2 or 3 Views $721 N/A $433
X-Ray of Knee, 3 Views $606 N/A $364
X-Ray of Knee, 4 Views $979 N/A $587
X-Ray of Low Back, 2 or 3 Views $588 N/A $353
X-Ray of Low Back, 4 Views $912 N/A $547
X-Ray of Neck, 2 or 3 Views $612 N/A $367
X-Ray of Shoulder, 2 Views $534 N/A $321
X-Ray of Wrist, 3 Views $541 N/A $325