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 62.8% reduction of charges with Dartmouth-Hitchcock Keene (DHK) and a 55% 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, 2017 and June 30, 2018

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* $46 $93 $139
Level 2* $94 $141 $235
Level 3* $139 $172 $311
Level 4* $200 $269 $469
Level 5* $273 $316 $589

*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* $11 $82 $93
Level 2* $33 $113 $146
Level 3* $72 $132 $204
Level 4* $112 $199 $311
Level 5* $191 $253 $444

*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* $194    $82 $276
Level 2* $246 $113 $359
Level 3* $324 $132 $456
Level 4* $439 $199 $638
Level 5* $567 $253 $820

*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 $140 $191 $331
Age 1-4 $149 $201 $350
Age 5-11 $144 $224 $368
Age 12-17 $190 $232 $422
Age 18-39 $155 $261 $416
Age 40-64 $195 $275 $470
Age 65 and up $213 $292 $505

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 $112 $148 $260
Age 1-4 $134 $145 $279
Age 5-11 $122 $157 $279
Age 12-17 $149 $184 $333
Age 18-39 $125 $239 $364
Age 40-64 $144 $253 $397
Age 65 and up $172 $266 $438

Eye Exams (Ophthalmology)
DHK Professional Charges CMC Hospital Charges Total Charge
New patient comprehensive* $166 $154 $320
New patient intermediate* $61 $146 $207
Established patient comprehensive* $123 $123 $246
Established patient intermediate* $72 $104 $176
Eye refraction $0 $68 $68

*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* $99 $202 $301
Level 2* $152 $309 $461
Level 3* $241 $535 $776
Level 4* $420 $833 $1,253
Level 5* $652 $1,071 $1,723

*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
$6,674 $7,102 $13,776
Newborn care
$376 $3,583 $3,959
Cesarean section
$7,453 $13,141 $20,594
Newborn care
$376 $4,439 $4,815
Tubal ligation w/c-section
$740 $0 $740
Discharge hospital
$260 $0 $260
Circumcision
$904 $2,878 $3,782
Level I OB ultrasound
$646 $0 $646
Newborn hearing test (pass/fail) $182 $0 $182

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* $2,140 $3,793 $5,933
Colonoscopy, with removal by snare technique* $3,224 $4,492 $7,716
Colonoscopy, flexible with biopsy* $3,224 $4,258 $7,482
Sigmoidoscopy, flexible* $681 $3,685 $4,366
Upper Gastrointestinal Endoscopy with biopsy* $2,023 $4,245 $6,268

*Estimates do not include pathology testing or interpreting.

Cheshire Medical Center is a charitable health care organization. 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.