Financial & Insurance Info

 

 

Fee Estimates for Health Care Services

Average charges are estimates; your out-of-pocket expense will depend on your individual insurance coverage (such as co-insurance or deductibles).

Uninsured patients are eligible for a 43% reduction of charges with Dartmouth-Hitchcock Keene (DHK) and a 45% reduction with Cheshire Medical Center. If you have questions, please contact Patient Accounts via email: patient.accounts@cheshire-med.com or by phone: (603) 354-5454 x4444.

These charges represent those of Dartmouth-Hitchcock Keene (DHK) and Cheshire Medical Center (CMC). There may be additional charges from other providers, such as Radiologists and Anesthesiologists depending on the services you receive.

Estimates valid between July 1, 2014 and June 30, 2015

Choose a visit type

Doctor's Office Visit for a New Patient
(first visit or patients not seen within the past 3 years)
D-HK Professional Charges CMC Hospital Charges Total Charge
Level 1* $42 $82 $124
Level 2* $83 $126 $209
Level 3* $124 $153 $277
Level 4* $178 $239 $417
Level 5* $243 $281 $524

 

*The complexity level of your visit is based on the nature of your condition, paperwork, examination and counseling time. Actual level is assigned after your visit.

Doctor's Office Visit for an Established Patient (return visit for follow-up)
D-HK Professional Charges CMC Hospital Charges Total Charge
Level 1* $0 $82 $82
Level 2* $29 $101 $130
Level 3* $64 $117 $181
Level 4* $100 $177 $277
Level 5* $170 $225 $395

 

*The complexity level of your visit is based on the nature of your condition, paperwork, examination and counseling time. Actual level is assigned after your visit.

Doctor's Office Visit for Consultation
(examination and coordination between healthcare providers)
D-HK Professional Charges CMC Hospital Charges Total Charge
Level 1* $164     $82 $246
Level 2* $218 $101 $319
Level 3* $289 $117 $406
Level 4* $391 $177 $568
Level 5* $505 $225 $730

 

*The complexity level of your visit is based on the nature of your condition, paperwork, examination and counseling time. Actual level is assigned after your visit.

Routine Annual Physical for New Patient
(charge is based on age groups and does not include diagnostic testing)
D-HK Professional Charges CMC Hospital Charges Total Charge
Age 0-1 $125 $170 $295
Age 1-4 $132 $180 $312
Age 5-11 $128 $199 $327
Age 12-17 $169 $207 $376
Age 18-39 $138 $231 $369
Age 40-64 $174 $244 $418
Age 65 and up $190 $260 $450

 

Routine Annual Physical for Established Patient
(charge is based on age groups and does not include diagnostic testing)
D-HK Professional Charges CMC Hospital Charges Total Charge
Age 0-1 $100 $131 $231
Age 1-4 $119 $133 $252
Age 5-11 $109 $139 $248
Age 12-17 $133 $163 $296
Age 18-39 $111 $213 $324
Age 40-64 $128 $225 $353
Age 65 and up $153 $236 $389

 

Eye Exams (Ophthalmology)
D-HK Professional Charges CMC Hospital Charges Total Charge
New patient comprehensive* $147 $138 $285
New patient intermediate* $54 $130 $184
Established patient comprehensive* $109 $110 $219
Established patient intermediate* $64 $93 $157
Eye refraction $0 $60 $60

 

*Definition of new or established patient: "A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the last three years."

Emergency Care Services
(unscheduled emergency visit for patients requiring immediate medical attention)
Charges do not include diagnostic testing such as lab services or X-rays. Charges do not include medications or observation charges. Call (603)354-5454 x4444 for more information.
Professional Charges CMC Hospital Charges Total Charge
Level 1* $90 $183 $273
Level 2* $138 $281 $419
Level 3* $218 $486 $704
Level 4* $381 $756 $1137
Level 5* $592 $971 $1,563

 

*The complexity level of your visit is based on the nature of your condition, paperwork, examination and counseling time. Actual level is assigned after your visit.

Maternity Care
D-HK Professional Charges CMC Hospital Charges Total Charge
Vaginal delivery
$5,937 $6,441 $12,378
Newborn care
$334 $3,250 $3,584
Cesarean section
$6,631 $11,920 $18,551
Newborn care
$334 $4,027 $4,361
Tubal ligation w/c-section
$703 $0 $703
Discharge hospital
$231 $0 $231
Circumcision
$804 $2,610 $3,414
Level I OB ultrasound
$575 $0 $575
Newborn hearing test (pass/fail) $163 $0 $163

 

Please note: All labs and ultrasounds are billed on a monthly basis as each patient's requirements differ. These fees are current and may change during the course of your pregnancy due to increases. Additional fees may be charged depending on the care required during your delivery. If these services are provided by anyone other than a Dartmouth-Hitchcock physician you will receive a bill from them. That provider will determine these fees. Please note that if you do not deliver at the Cheshire Medical Center you will be billed for any office visits you have had. Managed Care patients will be billed for any co-payments relating to office visits.

 

Colonoscopy, Upper Gastrointestinal Endoscopy & Sigmoidoscopy
D-HK Professional Charges CMC Hospital Charges Total Charge
Colonoscopy, flexible* $1,904 $3,441 $5,345
Colonoscopy, with removal by snare technique* $2,868 $4,075 $6,943
Colonoscopy, flexible with biopsy* $2,270 $3,863 $6,133
Sigmoidoscopy, flexible* $606 $3,343 $3,949
Upper Gastrointestinal Endoscopy with biopsy* $1,799 $3,850 $5,649

 

*Estimates do not include pathology testing or interpreting.

CMC and DHK are charitable health care organizations. We will treat patients who come to us for medically necessary care, regardless of their financial status. We offer financial assistance for these services - in the form of free or discounted care - to those patients who may have an inability to pay their bills. If you have any questions, would like an application for assistance or need to make payment arrangements, please contact Patient Financial Services at (603) 354-5454 x4444 Monday through Friday, 8:00 a.m. to 4:00 p.m.