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 - Head/Brain, without dye | $2316 | 0% | $2316 | Medium |
| MRI - Back (outpatient) | $1683 | 0% | $1683 | High |
| MRI - Brain (outpatient) | $3308 | 0% | $3308 | Medium |
| MRI - Knee (outpatient) | $1842 | 0% | $1842 | Medium |
| Ultrasound - Abdominal, Limited | $875 | 0% | $875 | Medium |
| X-Ray - Chest (outpatient) | $992 | 0% | $992 | Medium |
| X-Ray - Foot (outpatient) | $674 | 0% | $674 | High |
| X-Ray - Hand | $1149 | 0% | $1149 | Medium |
| X-Ray - Shoulder (outpatient) | $560 | 0% | $560 | Medium |
| X-Ray - Spine (outpatient) | $747 | 0% | $747 | High |
| X-Ray - Wrist (outpatient) | $525 | 0% | $525 | Medium |
Outpatient Tests and Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Arthrocentesis (outpatient) | $1433 | 0% | $1433 | Medium |
| Colonoscopy with biopsy (outpatient) | $5774 | 0% | $5774 | Medium |
| Colonoscopy with polyp removal (outpatient) | $5925 | 0% | $5925 | Medium |
| Diagnostic colonoscopy (outpatient) | $4740 | 0% | $4740 | Medium |
| Upper Gastrointestinal Endoscopy, with biopsy | $5333 | 0% | $5333 | Medium |
Laboratory Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Blood test for blood glucose control (Hemoglobin A1C) | $125 | 0% | $125 | Medium |
| Blood test for thyroxine (thyroid chemical) level, free | $163 | 0% | $163 | Medium |
| Blood test for vitamin B-12 (cyanocobalamin) level | $184 | 0% | $184 | Medium |
| Electrolytes Panel | $169 | 0% | $169 | Medium |
| Gonorrhoeae test (Neisseria gonorrhoeae bacteria) | $217 | 0% | $217 | Medium |
| Hepatic (Liver) Function Panel | $485 | 0% | $485 | Medium |
| Urinalysis test automated with microscope examination | $103 | 0% | $103 | Medium |
| Pregnancy test, urine | $144 | 0% | $144 | Medium |
| Test for disease-causing (pathogenic) organisms, not limited to a specific condition | $121 | 0% | $121 | 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 | $228 | 0% | $228 | Medium |
| Manual Therapy - PT | $86 | 0% | $86 | Medium |
| Therapeutic Exercises - PT | $92 | 0% | $92 | Medium |
| Ultrasound Therapy - PT | $36 | 0% | $36 | 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 | $261 | 0% | $261 | Medium |
| Group Session - Psychotherapy | $88 | 0% | $88 | Medium |
Emergency Visits
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Emergency Room Visit - Medium (outpatient) | $303 | 0% | $303 | Medium |
Ambulance Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Emergency Transport, Advanced Life Support - Ambulance Service | $1238 | 0% | $1238 | Medium |
| Mileage Rate for Ambulance Transport | $17 | 0% | $17 | Medium |
| Non-emergency Transport, Basic Life Support - Ambulance Service | $680 | 0% | $680 | Medium |