Average charges are estimates; your out-of-pocket expense will depend on your individual insurance coverage (such as co-insurance or deductibles).
While Cheshire Medical Center (CMC) now encompasses both our hospital’s inpatient services and outpatient clinics, some of our billing charges remain separate.
Uninsured patients are eligible for a 61.6% reduction of charges with Dartmouth Hitchcock Clinics Keene and a 64.3% reduction with Cheshire Medical Center.
Questions? Please call Dartmouth Health Patient Financial Services at 844-647-6436.
Our myDH patient portal website provides estimates for services provided at Dartmouth Health. Estimates can be requested for individual procedures and may factor in your specific insurance to estimate out-of-pocket expenses. Learn more about myDH Estimates.
Additional charges: These charges represent those of Dartmouth Hitchcock Clinics Keene and CMC. There may be additional charges from other contract providers, such as radiologists and anesthesiologists, depending on the services you receive.
Estimates valid between July 1, 2021 and June 30, 2022
Choose a visit type:
- COVID-19 testing
- COVID-19 vaccine and administration
- Telemedicine services
- Doctor's office visit for a new patient
- Doctor's office visit for an established patient
- Doctor's office visit for consultation
- Routine annual physical for a new patient
- Routine annual physical for an established patient
- Eye exams
- Emergency care center visit
- Maternity care
- Colonoscopy, upper gastrointestinal endoscopy and sigmoidoscopy
COVID-19 testing
Type of visit | Facility charge | Professional charge | Total charge |
---|---|---|---|
Sars-Cov-2 (Covid-19) Test | $150 | N/A | $150 |
Rapid Sars-Cov-2 (Covid-19) PCR Test | $190 | N/A | $190 |
Covid-19 IGG Antibody Test | $54 | N/A | $54 |
COVID-19 vaccine and administration
Type of visit | Facility charge | Professional charge | Total charge |
---|---|---|---|
Vaccine (no charge) | $0 | N/A | $0 |
Administration Dose One | N/A | $64 | $64 |
Administration Dose Two | N/A | $64 | $64 |
Telemedicine services
New patient
Type of visit | Facility charge | Professional charge | Total charge |
---|---|---|---|
Low-to-moderate-level visit (15-29 min) | N/A | $285 | $285 |
Moderate-level visit (30-44 min) | N/A | $376 | $376 |
Moderate-to-high-level visit (45-59 min) | N/A | $567 | $567 |
High-level visit (60-74 min) | N/A | $708 | $708 |
Established patient
Type of visit | Facility charge | Professional charge | Total charge |
---|---|---|---|
Low-to-moderate-level visit (10-19 min) | N/A | $175 | $175 |
Moderate-level visit (20-29 min) | N/A | $243 | $243 |
Moderate-to-high-level visit (30-39 min) | N/A | $374 | $374 |
High-level visit (40-54 min) | N/A | $530 | $530 |
Doctor's office visit for a new patient
Doctor's office visit for a new patient (first visit or patients not seen within the past three years) |
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Dartmouth Hitchcock Clinics Keene professional charges |
CMC hospital charges | Total charge | ||
Level 2* | $114 | $171 | $285 | |
Level 3* | $169 | $207 | $376 | |
Level 4* | $242 | $335 | $567 | |
Level 5* | $329 | $379 | $708 |
*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
Doctor's office visit for an established patient (return visit for follow-up) | ||||
Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Level 1* | $13 | $94 | $107 | |
Level 2* | $39 | $136 | $175 | |
Level 3* | $86 | $157 | $243 | |
Level 4* | $135 | $239 | $374 | |
Level 5* | $228 | $302 | $530 |
*The complexity level of your visit is based on the nature of your condition, paperwork, examination, and counseling time. The actual level is assigned after your visit.
Doctor's office visit for consultation
Doctor's office visit for consultation (examination and coordination between health care providers) |
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Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Level 1* | $294 | $40 | $334 | |
Level 2* | $353 | $81 | $434 | |
Level 3* | $439 | $114 | $553 | |
Level 4* | $591 | $183 | $774 | |
Level 5* | $763 | $224 | $987 |
*The complexity level of your visit is based on the nature of your condition, paperwork, examination, and counseling time. The actual level is assigned after your visit.
Routine annual physical for new patient
Routine annual physical for new patient (charge is based on age groups and does not include diagnostic testing) |
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Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Age 0-1 | $170 | $232 | $402 | |
Age 1-4 | $181 | $243 | $424 | |
Age 5-11 | $173 | $270 | $443 | |
Age 12-17 | $187 | $313 | $500 | |
Age 18-39 | $187 | $313 | $500 | |
Age 40-64 | $235 | $330 | $565 | |
Age 65 and up | $256 | $351 | $607 |
Routine annual physical for established patient
Routine annual physical for established patient (charge is based on age groups and does not include diagnostic testing) |
||||
Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Age 0-1 | $135 | $178 | $313 | |
Age 1-4 | $163 | $175 | $338 | |
Age 5-11 | $147 | $189 | $336 | |
Age 12-17 | $180 | $221 | $401 | |
Age 18-39 | $150 | $288 | $438 | |
Age 40-64 | $173 | $304 | $477 | |
Age 65 and up | $208 | $319 | $527 |
Eye exams (ophthalmology)
Eye exams (ophthalmology) | ||||
Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
New patient comprehensive* | $191 | $211 | $402 | |
New patient intermediate* | $71 | $193 | $264 | |
Established patient comprehensive* | $166 | $147 | $313 | |
Established patient intermediate* | $81 | $135 | $216 | |
Eye refraction | $24 | $58 | $82 |
*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
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. |
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Professional charges | CMC hospital charges | Total charge | ||
Level 1* | $117 | $240 | $357 | |
Level 2* | $186 | $414 | $600 | |
Level 3* | $292 | $721 | $1,013 | |
Level 4* | $510 | $1,166 | $1,676 | |
Level 5* | $791 | $1,698 | $2,489 |
*The complexity level of your visit is based on the nature of your condition, paperwork, examination, and counseling time. The actual level is assigned after your visit.
Maternity care
Maternity care | ||||
Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Vaginal delivery | $8,083 | $15,919 | $24,002 | |
Newborn care | $455 | $3,711 | $4,166 | |
Cesarean section | $9,025 | $17,317 | $26,342 | |
Tubal ligation w/c-section | $956 | $237 | $1,193 | |
Discharge hospital | $315 | $0 | $315 | |
Circumcision | $1,095 | $3,400 | $4,495 | |
Level I OB ultrasound | $283 | $489 | $772 | |
Newborn hearing test (pass/fail) | $93 | $157 | $250 |
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 Medical Center and Clinics 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 and sigmoidoscopy
Colonoscopy, upper gastrointestinal endoscopy and sigmoidoscopy | ||||
Dartmouth Hitchcock Clinics Keene professional charges | CMC hospital charges | Total charge | ||
Colonoscopy, flexible* | $2,592 | $5,725 | $8,317 | |
Colonoscopy, with removal by snare technique* | $3,905 | $7,044 | $10,949 | |
Colonoscopy, flexible with biopsy* | $3,089 | $7,408 | $10,497 | |
Sigmoidoscopy, flexible* | $825 | $5,773 | $6,598 | |
Upper gastrointestinal endoscopy with biopsy* | $2,450 | $7,030 | $9,480 |
*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 844-647-6436, Monday through Friday, 8:00 am to 4:00 pm.
Machine Readable Hospital List of Standard Charges (CSV)
The information provided is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital, also known as a chargemaster, which Cheshire Medical Center posts on an annual basis. Standard charges shown in the chargemaster do not necessarily reflect what a patient ultimately pays for services and therefore may not be a meaningful tool to estimate a patient’s out-of-pocket responsibility or to compare hospital costs. Actual charges may differ for a variety of reasons and Cheshire Medical Center does not hereby offer, promise, contract, guarantee, or assume any legally binding obligation to provide a selected service(s) or item(s) for the listed charge(s).
Because the chargemaster rates are updated periodically, patients should contact our patient financial services staff at 844-647-6436 for information about the cost of care.
Hospital Median Charges (XLSX)
The information provided is a comprehensive list of diagnosis-related group (DRG) charges provided at Cheshire Medical Center and the average charges associated with each. Every inpatient stay is unique based on patient needs, diagnosis, and level of care needed, and therefore charges relate to inpatient stays can differ on an individual patient basis. This list does not necessarily reflect what a patient ultimately pays for services and therefore may not be a helpful tool to estimate out-of-pocket responsibility or to compare hospital costs. Actual charges may differ for a variety of reasons and Cheshire does not hereby offer, promise, contract, guarantee or assume any legally binding obligation to provide a selected service(s) or item(s) for the listed charge(s). Patients are encouraged to contact Cheshire Medical Center patient financial services staff at 844-647-6436 for information about the cost of your care.