Wentworth-Douglass Hospital
(603) 742-5252
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Physicians
Lab
Procedures
Radiology
Services Offered

Radiology

For help with pricing information,
please call (603) 740-2205.

For help understanding your bill or
to make payment arrangements, please call our toll free customer service number at
(855) 762-5219.

All procedural prices listed below are subject to separate hospital facility fees and professional fees from physicians for their services. Prices will vary.

Discounts:

  • 40% discount for self-pay patients (patients with no insurance).
  • 20% prompt pay discount with full bill payment in 30 days. This applies to self-pay accounts and self-pay balances after insurance.
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
$567  $340 $848  $509
71020 Chest N/A  N/A $524  $314
73510/73520 Hip $415  $249 $460  $276
73030 Shoulder $567  $340 $848  $509
72050 Spine N/A  N/A $677  $406

 

 

 

 

 


 

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 $4,754  $2,852
70551 Brain MRI w/o contrast  N/A  N/A $4,724  $2.834
70553 Brain MRI w/wo contrast  N/A  N/A $4,958  $2,975
           
  Joint - Upper         
73222  Any Joint Upper Body w/contrast  $4,904  $2,942 $7,355  $4,413
73221  Any Joint Upper Body w/o contrast  $4,714  $2,828 $6,161  $3,697
73223  Any Joint Upper Body w/wo contrast   $5,200  $3,120 $7,801  $4,681
           
  Joint - Lower         
73722  Any Joint Lower Body w/contrast $4,442  $2,665 $6,663  $3,998
73721 Any Joint Lower Body w/o contrast  $4,433  $2,660 $6,649  $3,989
73723  Any Joint Lower Body w/wo contrast  $4,885  $2,931 $7,328  $4,397
           
  Spine - Lumbar         
72149  Lumbar w/contrast  N/A  N/A $5,262  $3,157
72148  Lumbar w/o contrast  N/A  N/A $5,019  $3,011
72158  Lumbar w/wo contrast  N/A  N/A $5,504  $3,302
           
  Spine - Cervical        
72142 Cervical w/contrast N/A  N/A $5,720  $3,432
72141 Cervical w/o contrast N/A  N/A $5,504  $3,302
72156 Cervical w/wo contrast N/A  N/A $6,003  $3,602

 

CPT Code CT Scan Cost No Insurance
Cost 
  Abdomen    
74160 Abdomen w/contrast $4,517  $2,710
74150 Abdomen w/o contrast  $3,126  $1,876
74170 Abdomen w/wo contrast  $4,904  $2,942
       
  Facial     
70487  Facial w/contrast  $1,901  $1,141
70486  Facial w/o contrast  $1,843  $1,106
70488  Facial w/wo contrast   $2,007  $1,204
       
  Head     
70460 Head/Brain w/contrast $4,098  $2,459
70450 Head/Brain w/o contrast  $2,822  $1,693
70470  Head/Brain w/wo contrast  $4,966  $2,980
       
  Pelvis    
72193  Pelvis w/contrast  $2,214  $1,328
72192  Pelvis w/o contrast  $1,892  $1,135
72194  Pelvis w/wo contrast  $2,244  $1,346
       
  Thorax (upper trunk)    
71260 Thorax w/contrast $4,472  $2,683
71250 Thorax w/o contrast $3,427  $2,056
71270 Thorax w/wo contrast $4,772  $2,863

 

CPT Code Ultrasound Cost No Insurance
Cost
76700 Abdomen
Complete Abdominal
$1,086  $652
76536 Head/Neck ST
Soft tissue of head/neck
$1,080  $648
76830 Vaginal
Transvaginal
$1,127  $676
76770 Kidney
Renal/Retroperitoneal
$680  $408
76870

Male Genitalia & Contents
Male Genitalia

$853  $512

 

 

  

 

 

 

 

 

 

For more information

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

 

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Address

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