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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
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 |
$464 |
$325 |
$696 |
$488 |
| 71020 |
Chest |
N/A |
N/A |
$429 |
$301 |
| 73510/73520 |
Hip |
$340 |
$238 |
$377 |
$264 |
| 73030 |
Shoulder |
$464 |
$325 |
$696 |
$488 |
| 72050 |
Spine |
N/A |
N/A |
$555 |
$389 |
| 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 |
$4,311 |
$3,018 |
| 70551 |
Brain MRI w/o contrast |
N/A |
N/A |
$4,284 |
$2,999 |
| 70553 |
Brain MRI w/wo contrast |
N/A |
N/A |
$4,496 |
$3,148 |
| |
|
|
|
|
|
| |
Joint - Upper |
|
|
|
|
| 73222 |
Any Joint Upper Body w/contrast |
$4,447 |
$3,113 |
$6,670 |
$4,669 |
| 73221 |
Any Joint Upper Body w/o contrast |
$4,275 |
$2,993 |
$5,587 |
$3,911 |
| 73223 |
Any Joint Upper Body w/wo contrast |
$4,716 |
$3,302 |
$7,075 |
$4,953 |
| |
|
|
|
|
|
| |
Joint - Lower |
|
|
|
|
| 73722 |
Any Joint Lower Body w/contrast |
$4,028 |
$2,820 |
$6,042 |
$4,230 |
| 73721 |
Any Joint Lower Body w/o contrast |
$4,020 |
$2,814 |
$6,030 |
$4,221 |
| 73723 |
Any Joint Lower Body w/wo contrast |
$4,430 |
$3,101 |
$6,646 |
$4,653 |
| |
|
|
|
|
|
| |
Spine - Lumbar |
|
|
|
|
| 72149 |
Lumbar w/contrast |
N/A |
N/A |
$4,772 |
$3,341 |
| 72148 |
Lumbar w/o contrast |
N/A |
N/A |
$4,552 |
$3,187 |
| 72158 |
Lumbar w/wo contrast |
N/A |
N/A |
$4,991 |
$3,494 |
| |
|
|
|
|
|
| |
Spine - Cervical |
|
|
|
|
| 72142 |
Cervical w/contrast |
N/A |
N/A |
$5,187 |
$3,631 |
| 72141 |
Cervical w/o contrast |
N/A |
N/A |
$4,991 |
$3,494 |
| 72156 |
Cervical w/wo contrast |
N/A |
N/A |
$5,444 |
$3,811 |
| CPT Code |
CT Scan |
Cost |
No Insurance
Cost |
| |
Abdomen |
|
|
| 74160 |
Abdomen w/contrast |
$4,096 |
$2,868 |
| 74150 |
Abdomen w/o contrast |
$2,835 |
$1,985 |
| 74170 |
Abdomen w/wo contrast |
$4,447 |
$3,113 |
| |
|
|
|
| |
Facial |
|
|
| 70487 |
Facial w/contrast |
$1,723 |
$1,207 |
| 70486 |
Facial w/o contrast |
$1,671 |
$1,170 |
| 70488 |
Facial w/wo contrast |
$1,820 |
$1,274 |
| |
|
|
|
| |
Head |
|
|
| 70460 |
Head/Brain w/contrast |
$3,716 |
$2,602 |
| 70450 |
Head/Brain w/o contrast |
$2,559 |
$1,792 |
| 70470 |
Head/Brain w/wo contrast |
$4,503 |
$3,153 |
| |
|
|
|
| |
Pelvis |
|
|
| 72193 |
Pelvis w/contrast |
$2,007 |
$1,405 |
| 72192 |
Pelvis w/o contrast |
$1,715 |
$1,201 |
| 72194 |
Pelvis w/wo contrast |
$2,035 |
$1,425 |
| |
|
|
|
| |
Thorax (upper trunk) |
|
|
| 71260 |
Thorax w/contrast |
$4,056 |
$2,840 |
| 71250 |
Thorax w/o contrast |
$3,107 |
$2,175 |
| 71270 |
Thorax w/wo contrast |
$4,327 |
$3,029 |
| CPT Code |
Ultrasound |
Cost |
No Insurance
Cost |
| 76700 |
Abdomen
Complete Abdominal |
$940 |
$658 |
| 76536 |
Head/Neck ST
Soft tissue of head/neck |
$934 |
$654 |
| 76830 |
Vaginal
Transvaginal |
$975 |
$683 |
| 76770 |
Kidney
Renal/Retroperitoneal |
$588 |
$412 |
| 76870 |
Male Genitalia & Contents
Male Genitalia
|
$738 |
$517 |
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