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 58% 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, 2016 and June 30, 2017

Choose a visit type

Doctor's Office Visit for a New Patient
(first visit or patients not seen within the past 3 years)
DHK Professional Charges CMC Hospital Charges Total Charge
Level 1* $44 $88 $132
Level 2* $89 $134 $223
Level 3* $132 $163 $295
Level 4* $190 $254 $444
Level 5* $259 $299 $558

*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)
DHK Professional Charges CMC Hospital Charges Total Charge
Level 1* $0 $88 $88
Level 2* $31 $107 $138
Level 3* $68 $125 $193
Level 4* $106 $189 $295
Level 5* $181 $240 $421

*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)
DHK Professional Charges CMC Hospital Charges Total Charge
Level 1* $174 $88 $262
Level 2* $233 $107 $340
Level 3* $307 $125 $432
Level 4* $416 $189 $605
Level 5* $537 $240 $777

*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)
DHK Professional Charges CMC Hospital Charges Total Charge
Age 0-1 $133 $181 $314
Age 1-4 $141 $191 $332
Age 5-11 $136 $213 $349
Age 12-17 $180 $220 $400
Age 18-39 $147 $247 $394
Age 40-64 $185 $260 $445
Age 65 and up $202 $277 $479

Routine Annual Physical for Established Patient
(charge is based on age groups and does not include diagnostic testing)
DHK Professional Charges CMC Hospital Charges Total Charge
Age 0-1 $106 $140 $246
Age 1-4 $127 $141 $268
Age 5-11 $116 $148 $264
Age 12-17 $141 $175 $316
Age 18-39 $118 $227 $345
Age 40-64 $136 $240 $376
Age 65 and up $163 $252 $415

Eye Exams (Ophthalmology)
DHK Professional Charges CMC Hospital Charges Total Charge
New patient comprehensive* $157 $146 $303
New patient intermediate* $58 $138 $196
Established patient comprehensive* $117 $116 $233
Established patient intermediate* $68 $99 $167
Eye refraction $0 $64 $64

*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
DHK Professional Charges CMC Hospital Charges Total Charge
Vaginal delivery
$6,325 $6,763 $13,088
Newborn care
$356 $3,413 $3,769
Cesarean section
$7,063 $12,516 $19,579
Newborn care
$356 $4,228 $4,584
Tubal ligation w/c-section
$749 $0 $7249
Discharge hospital
$246 $0 $246
Circumcision
$857 $2,741 $3,598
Level I OB ultrasound
$612 $0 $612
Newborn hearing test (pass/fail) $173 $0 $173

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
DHK Professional Charges CMC Hospital Charges Total Charge
Colonoscopy, flexible* $2,028 $3,613 $5,641
Colonoscopy, with removal by snare technique* $3,055 $4,279 $7,334
Colonoscopy, flexible with biopsy* $3,055 $4,056 $7,111
Sigmoidoscopy, flexible* $645 $3,510 $4,155
Upper Gastrointestinal Endoscopy with biopsy* $1,917 $4,043 $5,960

*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.