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 64% reduction of charges with Dartmouth Hitchcock Clinics Keene and a 68.5% 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, 2023 and June 30, 2024
CT (computed tomography) scans
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Abdominal CT scan, with contrast | $3,483 | $506 | $3,989 |
| Chest CT scan, without contrast | $2,410 | $485 | $2,895 |
| Head CT scan, without contrast | $1,781 | $378 | $2,159 |
| Pelvis CT scan, with contrast | $2,612 | $495 | $3,107 |
| Pelvis CT scan, without contrast, followed by contrast | $3,291 | $493 | $3,784 |
| Sinus CT scan, limited, without contrast | $2,197 | $435 | $2,632 |
Digestive, intestinal, and gastroenterology
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Colonoscopy screening | $3,247 | $3,028 | $6,275 |
| Colonoscopy with polyp removal | $3,533 | $5,493 | $9,026 |
| Endoscopy (upper gastrointestinal) | $3,247 | $2,483 | $5,730 |
| Endoscopy with biopsy (upper gastrointestinal) | $3,247 | $3,164 | $6,411 |
| Sigmoidoscopy (colon cancer screening test, with local anesthesia) | $3,171 | $1,126 | $4,297 |
EKG (electrocardiogram), stress tests, and echocardiograms
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Echocardiogram, transthoracic, complete with color flow | $2,479 | $662 | $3,141 |
| Electrocardiogram (ECG) | $348 | $112 | $460 |
| Nuclear stress test | $10,830 | $1,169 | $11,999 |
| Stress test with echocardiogram (real-time image) | $2,004 | $984 | $2,988 |
Lab tests
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Basic metabolic panel | $77 | N/A | $77 |
| Complete blood count (CBC) | $82 | N/A | $82 |
| Comprehensive metabolic panel | $352 | N/A | $352 |
| Glucose test | $49 | N/A | $49 |
| Hemoglobin A1c | $104 | N/A | $104 |
| Lipid profile | $122 | N/A | $122 |
| Pap test | $221 | N/A | $221 |
| Prostate specific antigen (PSA) | $207 | N/A | $207 |
| Routine blood draw | $40 | N/A | $40 |
| Strep test | $130 | N/A | $130 |
| Thyroid stimulating hormone (TSH) | $178 | N/A | $178 |
| Urinalysis (urine analysis) | $65 | N/A | $65 |
Mammograms
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Diagnostic mammogram with digitization and computer-aided detection (both breasts) | $716 | $212 | $928 |
| Screening mammogram with digitization and computer-aided detection (both breasts) | $698 | $178 | $876 |
MRI (magnetic resonance imaging) scans
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Brain MRI, without contrast | $4,635 | $570 | $5,205 |
| Brain MRI, without contrast, followed by contrast | $9,085 | $1,168 | $10,253 |
| Cervical spine MRI, without contrast | $4,635 | $643 | $5,278 |
| Knee MRI, without contrast | $3,163 | $544 | $3,707 |
| Pelvis MRI, without contrast, followed by contrast | $6,181 | $1,055 | $7,236 |
| Spine MRI, without contrast | $4,635 | $654 | $5,289 |
Neurology
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| EEG, awake and asleep | $968 | $536 | $1,504 |
PET (positron emission tomography) scans
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Whole body scan (PET) | $7,351 | $931 | $8,282 |
Pregnancy and prenatal tests
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| ABO type (blood typing) | $81 | N/A | $81 |
| Fetal non-stress test | $433 | $251 | $684 |
| Obstetric ultrasound, after first trimester | $939 | $361 | $1,300 |
| Obstetric ultrasound, after first trimester, limited | $566 | $258 | $824 |
| Obstetric ultrasound, first trimester | $262 | $358 | $358 |
| Pregnancy test, blood | $86 | N/A | $86 |
| Pregnancy test, urine (Office) | $80 | N/A | $80 |
| Rh type | $81 | N/A | $81 |
| Urine culture | $154 | N/A | $154 |
Ultrasounds
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Abdominal ultrasound, complete | $1,290 | $314 | $1,604 |
| Breast ultrasound, complete | $690 | $169 | $859 |
| Breast ultrasound, limited | $461 | $179 | $640 |
| Ultrasound, pelvis, complete | $1,254 | $322 | $1,576 |
| Vaginal ultrasound (not obstetric) | $1,035 | $365 | $1400 |
X-rays
| Type of visit | Facility charge | Professional charge | Total charge |
|---|---|---|---|
| Ankle X-ray (3+ views) | $526 | $105 | $631 |
| Bone density scan (DEXA scan) | $732 | $229 | $961 |
| Chest X-ray (single view) | $478 | $85 | $563 |
| Chest X-ray (2 views) | $516 | $100 | $616 |
| Foot X-ray | $516 | $103 | $619 |
| Lumbar spine X-ray (2 or 3 views) | $606 | $120 | $726 |
| Spine X-ray | $400 | $65 | $465 |