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 42% reduction of charges. 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, 2013 and June 30, 2014

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* $41 $79 $120
Level 2* $80 $122 $202
Level 3* $120 $148 $268
Level 4* $172 $231 $403
Level 5* $235 $271 $506

 

*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 $79 $79
Level 2* $42 $84 $126
Level 3* $62 $113 $175
Level 4* $97 $171 $268
Level 5* $163 $219 $382

 

*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* $159     $79 $238
Level 2* $224 $84 $308
Level 3* $279 $113 $392
Level 4* $378 $171 $549
Level 5* $486 $219 $705

 

*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 $121 $164 $285
Age 1-4 $128 $173 $301
Age 5-11 $124 $192 $316
Age 12-17 $162 $201 $363
Age 18-39 $132 $225 $357
Age 40-64 $168 $236 $404
Age 65 and up $184 $251 $435

 

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 $98 $124 $222
Age 1-4 $115 $128 $243
Age 5-11 $104 $136 $240
Age 12-17 $129 $157 $286
Age 18-39 $107 $206 $313
Age 40-64 $125 $216 $341
Age 65 and up $148 $228 $376

 

Eye Exams (Ophthalmology)
D-HK Professional Charges CMC Hospital Charges Total Charge
New patient comprehensive* $141 $134 $275
New patient intermediate* $52 $126 $178
Established patient comprehensive* $105 $107 $212
Established patient intermediate* $62 $90 $152
Eye refraction $0 $58 $58

 

*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* $85 $175 $260
Level 2* $132 $267 $399
Level 3* $207 $463 $670
Level 4* $362 $720 $1082
Level 5* $564 $925 $1,489

 

*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
$5,735 $6,134 $11,869
Newborn care
$323 $3,095 $3,418
Cesarean section
$6,606 $11,352 $17,958
Newborn care
$323 $3,835 $4,158
Tubal ligation w/c-section
$679 $0 $679
Discharge hospital
$223 $0 $223
Circumcision
$777 $2,486 $3,263
Level I OB ultrasound
$555 $0 $555
Newborn hearing test (pass/fail) $190 $0 $190

 

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* $1,839 $3,277 $5,116
Colonoscopy, with removal by snare technique* $2,868 $3,881 $6,749
Colonoscopy, flexible with biopsy* $2,178 $3,679 $5,857
Sigmoidoscopy, flexible* $585 $3,184 $3,769
Upper Gastrointestinal Endoscopy with biopsy* $1,738 $3,667 $5,405

 

*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.