Medical Charges

New London Hospital is providing this price list containing some of our charges for room
and board, emergency department, operating room, physical therapy and other
procedures. This information is for the patient to receive basic, facility-specific
information about services and charges. This is only a partial listing of charges for more
information please contact one of our financial advisors at (603) 526-5292 or e-mail to
billing@newlondonhospital.org We welcome your email about your account but due to
our dedication to keeping your information secure we will respond to any emails by
regular US postal mail.

• Hospital charges are the same for all patients, but a patient's responsibility may vary,
depending on payment plans negotiated with individual health insurances companies.

• Uninsured patients should consult with our Financial Counselors in Revenue Cycle
Services to determine whether they qualify for fincancial assistance.

• Medicare and Medicaid cover medically necessary services. Medicare does not cover
convenience items or self-administered pharmacy for outpatient, observation or
ambulatory surgery.

• The rates below will be charged beginning on the day of admission but not on the day
of discharge.

• The charge for an Observation Bed is per minute. This rate will be charged from the
time of admission to the time of discharge. The rate tops at $1221.00 per day

These prices are effective as of October 1, 2013.

PROVIDER OFFICE VISIT CHARGES:
The following charges reflect the most common services offered by our Physician Provider Groups.

OFFICE VISIT
ESTABLISHED PATIENT / NEW PATIENT

ESTABLISHED
PATIENT

NEW PATIENT

BRIEF EXAM

$65.00

$103.00

EXPANDED EXAM

$84.00

$145.00

DETAIL EXAM

$115.00

$225.00

MOD COMPLEX EXAM

$194.00

$291.00

HIGH COMPLEX EXAM

$256.00

$371.00

CONSULTATION CHARGES
(ESTABLISHED AND NEW PATIENTS):

FOCUSED EXAM

$208.00

EXPANDED EXAM

$273.00

DETAILED EXAM

$345.00

COMPREHENSIVE EXAM

$482.00

COMPLEX EXAM

$642.00

OTHER COMMON PROCEDURES PREFORMED

EAR IRRIGATION

$142.00

EKG

$160.00

NEBULIZER TREATMENT

$61.00

UNNA BOOT APPLICATION

$195.00

ALLERGY INJECTION

$38.00

ALLERGY INJECTION (MULTI)

$46.00

HOSPITAL CHARGES

ROOM AND BOARD - PER DAY

PRIVATE ROOM RATE MSN

$1,221.00

TELEMETRY BED

$1,841.00

SPECIAL CARE ROOM RATE

$2,698.00

SNF SWING PRIVATE RM RATE MSN

$995.00

The Clough Center - Nursing Home

ROOM AND BOARD - PER DAY

SNF CLOUGH ROOM RATE

$655.00

SNF CLOUGH PRIVATE ROOM

$952.00

CLOUGH INTERMEDIATE CARE

$291.00

CLOUGH INTERMEDIATE CARE PRIVATE

$344.00

CLOUGH INTERMEDIATE 3-4 BED

$279.00


Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the intensity of care, amount of time needed to provide treatment and personnel resources. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. Each patient seen in the Emergency Department will be charged a hospital technical level and a professional level charge fee.

Emergency Department

ER ROOM LEVEL I

$219.00

ER ROOM LEVEL II

$347.00

ER ROOM LEVEL III

$511.00

ER ROOM LEVEL IV

$751.00

ER ROOM LEVEL V

$1,122.00

ER ROOM CRITICAL CARE

$1,230.00

Physician Professional Fee for Emergency Room

ER PRO FEE LEVEL I

$128.00

ER PRO FEE LEVEL II

$169.00

ER PRO FEE LEVEL III

$255.00

ER PRO FEE LEVEL IV

$391.00

ER PRO FEE LEVEL V

$588.00

ER PRO FEE CRITICAL CARE

$631.00

Ambulance Services

AMB BLS RATE EMERGENCY

$1,263.00

AMB BLS RATE NONEMERGENCY

$732.00

AMBULANCE LOADED MILE

$37.00

AMBULANCE OXYGEN SERVICE

$78.00


Operating Room charges are based on te type of procedure performed. Additional charges are incurred for surgical supplies utilized during the procedure.

OPERATING ROOM CHARGES

 

OR-INPT/15 MIN.

$1,248.00

OR-OPD/15 MIN.

$1,248.00

OR-SURGICARE/1 MINUTE

$82.00

ENDO AND COLONOSCOPY CHARGE

$2,069.00

SIGMOIDOSCOPY (FLEX)

$934.00

ENDO OR COLONOSCOPY CHARGE

$1,484.00


The following charges reflect the most common services offered by our Physical Therapy Department. Patients may have additional charges, depending on the services performed.

PHYSICIAL THERAPY CHARGES

PT EVALUATION/UNTIMED

$255.00

PT GAIT TRAINING/15 MIN

$104.00

PT RE-EVALUATION/UNTIMED

$159.00

PT ULTRASOUND/15 MIN

$82.00

E STIM, TENS SET UP/15 MIN

$124.00

THERAPEUTIC ACTIVITIES/15MIN

$124.00

THERAPEUTIC EXERCISE/15 MIN

$111.00

(ST) DYSPHAGIA THERAPY/UNTIMED

$352.00

(ST) SPEECH TREATMENT/UNTIMED

$263.00

(ST)DYSPHAGIA EVALUATION

$564.00

(ST)SPEECH EVALUATION

$362.00


The following charges reflect the hospital's most common x-ray and radiological procedures.

XRAY AND RADIOLOGICAL CHARGES

CHEST-1 VIEW

$216.00

CHEST-4 VIEWS

$264.00

DEXA SCAN

$532.00

CT-ABDOMEN-W/CONTRAST

$1,524.00

CT-ABDOMEN-W/O CONTRAST

$1,315.00

CT-HEAD-W/CONTRAST

$1,340.00

CT-HEAD-W/O CONTRAST

$1,321.00

CT-PELVIS-W/CONTRAST

$1,524.00

CT-PELVIS-W/O CONTRAST

$1,467.00

MR-BRAIN W/ CONTRAST

$3,128.00

MR-BRAIN W/O CONTRAST

$2,482.00

PELVIS 1 OR 2 VIEWS

$216.00

MAMMO-DIGITAL SCREENING

$560.00

MAMMO DIGITAL DIAGNOSTIC

$485.00

MAMMO DIAGNOSTIC BILAT W/CAD

$579.00

MAMMO SCREENING W/CAD

$654.00


The following charges reflect the hospital's most common laboratory procedures.

LABORATORY CHARGES

 

VENOUS SPECIMEN COLLECTION FEE

$24.00

CBC FOR PANEL

$46.00

CHOLESTEROL, TOTAL - SERUM

$39.00

CULTURE URINE

$46.00

URINE DIP

$19.00

TSH

$124.00

ELECTROLYTES

$51.00

HEMOGLOBIN A1C

$69.00

GLUCOSE-SERUM

$30.00

T4

$82.00

PSA - SCREENING

$106.00

PSA - DIAGNOSTIC

$106.00

POTASSIUM-SERUM

$35.00


The following charge s reflect the most common services offered b our Cardiopulmonary Department. Patients may have additional charges, depending on the services performed.

CARDIOPULMONARY CHARGES

CARDIAC LOOP INTERP

$116.00

CARDIAC LOOP HOOKUP

$177.00

BP MONITORING

$274.00

HOLTER MONITOR

$452.00

STRESS TEST

$699.00

EKG INTERP & REPORT

$83.00

EKG

$77.00

ECHOCARDIOGRAM

$2,450.00

PULMONARY FUNCTION TEST PRE/POST

$499.00

PULMONARY FUNCTION TEST/SCREEN

$130.00

SLEEP LAB

SLEEP STAGING W/4 OR >PARAM,ATTEN

$2,277.00

SLEEP STAGING W/CPAP OR BIPAP

$2,239.00

SLEEP STAGING W/4 OR> PARAM SPLIT

$2,277.00

SLEEP STAGING W/CPAP/BPAP SPLIT

$2,239.00

MULTIPLE SLEEP LATENCY TEST

$2,238.00



Pricing does not include services for Radiology or Pathology physicians. That information may be requested by contacting:

Valley Radiology AMS Plus, Inc. 91 Stiles Rd Salem, NH 03079 Telephone 800-927-0118

Pathology Triad Medical Services 71 Lyme Rd Hanover, NH 03755 Telephone 603-643-1405

If you should have any questions regarding any of the information listed above please
contact New London Hospital's Revenue Cycle Services staff at 1.603.526.5292

Thank you and we hope this information was helpful.