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, 2015 and June 30, 2016

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* $43 $85 $128
Level 2* $86 $130 $216
Level 3* $128 $158 $286
Level 4* $184 $247 $431
Level 5* $251 $291 $542

*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 $85 $85
Level 2* $30 $104 $134
Level 3* $66 $121 $187
Level 4* $103 $183 $286
Level 5* $176 $233 $409

*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* $169 $85 $254
Level 2* $226 $104 $330
Level 3* $299 $121 $420
Level 4* $404 $183 $587
Level 5* $522 $233 $755

*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 $129 $176 $305
Age 1-4 $138 $185 $323
Age 5-11 $132 $206 $338
Age 12-17 $175 $214 $389
Age 18-39 $143 $240 $383
Age 40-64 $180 $252 $432
Age 65 and up $196 $269 $465

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 $103 $135 $238
Age 1-4 $123 $138 $261
Age 5-11 $113 $144 $257
Age 12-17 $138 $169 $307
Age 18-39 $115 $220 $335
Age 40-64 $132 $233 $365
Age 65 and up $158 $244 $402

Eye Exams (Ophthalmology)
D-HK Professional Charges CMC Hospital Charges Total Charge
New patient comprehensive* $152 $143 $295
New patient intermediate* $56 $134 $190
Established patient comprehensive* $114 $113 $227
Established patient intermediate* $66 $96 $162
Eye refraction $0 $62 $62

*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* $94 $193 $287
Level 2* $145 $295 $440
Level 3* $229 $510 $739
Level 4* $400 $793 $1,193
Level 5* $621 $1,020 $1,641

*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
$6,134 $6,763 $12,897
Newborn care
$345 $3,413 $3,758
Cesarean section
$6,850 $12,516 $19,366
Newborn care
$345 $4,228 $4,573
Tubal ligation w/c-section
$726 $0 $726
Discharge hospital
$239 $0 $239
Circumcision
$831 $2,741 $3,572
Level I OB ultrasound
$594 $0 $594
Newborn hearing test (pass/fail) $168 $0 $168

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* $1,967 $3,613 $5,580
Colonoscopy, with removal by snare technique* $2,963 $4,279 $7,242
Colonoscopy, flexible with biopsy* $2,345 $4,056 $6,401
Sigmoidoscopy, flexible* $626 $3,510 $4,136
Upper Gastrointestinal Endoscopy with biopsy* $1,859 $4,043 $5,902

*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.