Wentworth-Douglass Hospital
(603) 742-5252
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Radiology

All listed Radiology prices are subject to separate professional fees which are not included below.
Professional Fees:
               1.) Wentworth-Douglass Hospital for facility expenses
               2.) Physicians for their evaluation and treatment
               3.) Radiology Physicians for reading and radiology services 

WDH offers a 40% discount for self-pay patients (patients with no insurance). Additionally, WDH  will offer a 20% prompt pay discount on deductibles and co insurance amounts with bill payment in full within the first 30 days.

For more information, call:

Price Estimates at (603) 740-2205
Customer Service at 1 (855) 762-5219
Pre-Registration at (603) 740-2493
Scheduling at (603) 740-2224   

 

CPT Code X-ray Right or Left  No Insurance
Right or Left
Both Sides No Insurance
Both Sides 
73610/73110
73630/73130
Ankle/Wrist/Foot/Hand
3 views
$488  $293 $736  $442
71020 Chest N/A  N/A $451  $271
73510/73520 Hip $357  $214 $396  $238
73030 Shoulder $488  $293 $731  $439
72050 Spine N/A  N/A $583  $350

 

 

 

 

 


 

CPT Code MRI Right or Left  No Insurance
Right or Left
Both Sides  No Insurance
Both Sides
  Brain        
70552 Brain MRI w/contrast N/A  N/A $4,527  $2,716
70551 Brain MRI w/o contrast  N/A  N/A $4,499  $2.699
70553 Brain MRI w/wo contrast  N/A  N/A $4,721  $2,833
           
  Joint - Upper         
73222  Any Joint Upper Body w/contrast  $4,670  $3,269 $7,004  $4,202
73221  Any Joint Upper Body w/o contrast  $4,489  $3,142 $5,867  $3,520
73223  Any Joint Upper Body w/wo contrast   $4,952  $3,466 $7,429  $4,457
           
  Joint - Lower         
73722  Any Joint Lower Body w/contrast $4,230  $2,961 $6,345  $3,807
73721 Any Joint Lower Body w/o contrast  $4,221  $2,955 $6,332  $3,799
73723  Any Joint Lower Body w/wo contrast  $4,652  $3,256 $6,979  $4,187
           
  Spine - Lumbar         
72149  Lumbar w/contrast  N/A  N/A $5,011  $3,007
72148  Lumbar w/o contrast  N/A  N/A $4,780  $2,868
72158  Lumbar w/wo contrast  N/A  N/A $5,241  $3,145
           
  Spine - Cervical        
72142 Cervical w/contrast N/A  N/A $5,447  $3,268
72141 Cervical w/o contrast N/A  N/A $5,241  $3,145
72156 Cervical w/wo contrast N/A  N/A $5,717  $3,430

 

CPT Code CT Scan Cost No Insurance
Cost 
  Abdomen    
74160 Abdomen w/contrast $4,301  $2,581
74150 Abdomen w/o contrast  $2,977  $1,786
74170 Abdomen w/wo contrast  $4,670  $2,802
       
  Facial     
70487  Facial w/contrast  $1,810  $1,086
70486  Facial w/o contrast  $1,755  $1,053
70488  Facial w/wo contrast   $1,911  $1,147
       
  Head     
70460 Head/Brain w/contrast $3,902  $2,341
70450 Head/Brain w/o contrast  $2,687  $1,612
70470  Head/Brain w/wo contrast  $4,729  $2,837
       
  Pelvis    
72193  Pelvis w/contrast  $2,108  $1,265
72192  Pelvis w/o contrast  $1,801  $1,081
72194  Pelvis w/wo contrast  $2,137  $1,282
       
  Thorax (upper trunk)    
71260 Thorax w/contrast $4,259  $2,555
71250 Thorax w/o contrast $3,263  $1,958
71270 Thorax w/wo contrast $4,544  $2,726

 

CPT Code Ultrasound Cost No Insurance
Cost
76700 Abdomen
Complete Abdominal
$987  $592
76536 Head/Neck ST
Soft tissue of head/neck
$981  $589
76830 Vaginal
Transvaginal
$1,024  $614
76770 Kidney
Renal/Retroperitoneal
$618  $371
76870

Male Genitalia & Contents
Male Genitalia

$775  $465

 

 

  

 

 

 

 

 

 

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Address

Wentworth-Douglass Hospital
789 Central Avenue, Dover, NH 03820
Phone: (603) 742-5252
Toll free: 1 (877) 201-7100