Veterans Administration Medical Center
718 Smyth Road Manchester, NH 03104
Medical Procedures
Radiology Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| CT - Abdomen & Pelvis, with contrast | $2283 | 0% | $2283 | Medium |
| CT - Head/Brain, without dye | $1490 | 0% | $1490 | High |
| MRI - Back (outpatient) | $1683 | 0% | $1683 | Medium |
| MRI - Knee (outpatient) | $1752 | 0% | $1752 | Medium |
| Ultrasound - Abdominal, Limited | $1005 | 0% | $1005 | High |
| X-Ray - Ankle (outpatient) | $503 | 0% | $503 | Medium |
| X-Ray - Chest (outpatient) | $992 | 0% | $992 | Medium |
| X-Ray - Foot (outpatient) | $746 | 0% | $746 | High |
| X-Ray - Hand | $1134 | 0% | $1134 | Medium |
| X-Ray - Shoulder (outpatient) | $864 | 0% | $864 | High |
| X-Ray - Spine (outpatient) | $700 | 0% | $700 | High |
Outpatient Tests and Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Arthrocentesis (outpatient) | $1358 | 0% | $1358 | Medium |
| Colonoscopy with biopsy (outpatient) | $6964 | 0% | $6964 | Medium |
| Upper Gastrointestinal Endoscopy, with biopsy | $5283 | 0% | $5283 | Medium |
Laboratory Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Blood test for clotting time | $81 | 0% | $81 | Medium |
| Blood test for thyroxine (thyroid chemical) level, free | $163 | 0% | $163 | Medium |
| Electrolytes Panel | $169 | 0% | $169 | Medium |
| Urinalysis test automated with microscope examination | $103 | 0% | $103 | Medium |
| Test for vitamin D-3 level | $377 | 0% | $377 | Medium |
| Urinalysis test automated without microscope | $79 | 0% | $79 | Medium |
Physical Therapy
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Low Complexity Evaluation - PT | $212 | 0% | $212 | Medium |
Behavioral Health Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| 30 Minute - Psychotherapy | $176 | 0% | $176 | Medium |
| Diagnostic Evaluation - Psychiatric | $281 | 0% | $281 | Medium |
| Group Session - Psychotherapy | $256 | 0% | $256 | Medium |
Emergency Visits
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Emergency Room Visit - Medium (outpatient) | $1010 | 0% | $1010 | Medium |
Ambulance Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Emergency Transport, Advanced Life Support - Ambulance Service | $1133 | 0% | $1133 | Medium |
| Mileage Rate for Ambulance Transport | $16 | 0% | $16 | Medium |