Does Wentworth-Douglass Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Wentworth-Douglass Hospital. In a medical emergency, call 911.

Where is Wentworth-Douglass Hospital?

789 Central Ave, Dover, NH 03820, in Strafford County, New Hampshire.

What is the phone number of Wentworth-Douglass Hospital?

(603) 740-2580, as listed by Medicare (CMS).

What is the Medicare star rating of Wentworth-Douglass Hospital?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Wentworth-Douglass Hospital — Dover, NH

Quick answers

Does Wentworth-Douglass Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Wentworth-Douglass Hospital. In a medical emergency, call 911.
Where is Wentworth-Douglass Hospital?: 789 Central Ave, Dover, NH 03820, in Strafford County, New Hampshire.
What is the phone number of Wentworth-Douglass Hospital?: (603) 740-2580, as listed by Medicare (CMS).
What is the Medicare star rating of Wentworth-Douglass Hospital?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4][6][7]

Cancer
Heart
Pediatrics
Maternal health
Gastroenterology
Orthopedic surgery
Emergency medicine
Cardiovascular services
Critical care
Surgical services and anesthesia
Women and children's services
Diabetes services
Respiratory therapy
Wound healing

Treatments^[7][8]

Procedures^[7]

Cardiac catheterization
Electrophysiology
Echocardiography
Stress/nuclear cardiac testing
Vascular ultrasound

Programs and centers^[4][7][8]

Cancer Center (Mass General Brigham Cancer Institute at Wentworth-Douglass)
Cardiac rehabilitation
Device clinic (cardiac)
Wound Healing Institute
Observation Unit
Care-Van courtesy transportation for extended treatments
Courtesy Shuttle

Emergency care (hospital website)^[4]

Emergency room	Yes

Visiting and practical information

Parking	Dover campus parking garage; Courtesy Shuttle from garage to main entrance, weekdays 8 a.m.-4 p.m^[4]
Interpreters and languages	Interpreter phone line 1-844-311-9901 for all languages except Spanish (833-625-9606) and Indonesian (855-938-0457)^[5]
Patient portal	Patient Gateway

Recognition^[7]

Magnet Recognition (ANCC)
Baby-Friendly Hospital
Primary Stroke Center Certification (Joint Commission)
Level 3 Adult and Pediatric Trauma Center

Doctors and clinicians (1,385)

1,385 doctors and other clinicians list Wentworth-Douglass Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

And 1,361 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Frisbie Memorial Hospital8.5 mi · Rochester, NH · Acute Care Hospital
Portsmouth Regional Hospital11 mi · Portsmouth, NH · Acute Care Hospital
York Hospital12 mi · York, ME · Acute Care Hospital
Exeter Hospital Inc16 mi · Exeter, NH · Acute Care Hospital
Anna Jaques Hospital27 mi · Newburyport, MA · Acute Care Hospital

Other hospitals nearby

Huggins Hospital30 mi · Wolfeboro, NH · Critical Access Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Dover Center for Health & Rehabilitation0.8 mi · Dover, NH · 4 of 5 stars
Langdon Place of Dover2.3 mi · Dover, NH · 5 of 5 stars
Riverside Rest Home3.3 mi · Dover, NH · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Wentworth Home Care & Hospice, An Amedisys Partner2.9 mi · Somersworth, NH · 4 of 5 stars
Unity Hospice, LLC6.9 mi · Durham, NH
Cornerstone VNA8.5 mi · Rochester, NH · 4 of 5 stars

All hospice providers in the state →

Home health agencies

Wentworth Home Care & Hospice, An Amedisys Partner2.9 mi · Somersworth, NH
Cornerstone VNA8.5 mi · Rochester, NH
Amedisys Home Health10 mi · Portsmouth, NH

All home health agencies in the state →

Dialysis facilities

Fresenius Medical Care of Cocheco River1.8 mi · Dover, NH · 2 of 5 stars
FMC Strafford County Dialysis8.5 mi · Rochester, NH · 3 of 5 stars
FMC Seacoast Dialysis Center10 mi · Portsmouth, NH · 4 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Wentworth Surgery Center, LLC2.9 mi · Somersworth, NH
Barrington Surgical Care LLC8.3 mi · Barrington, NH
Coastal Surgical Center LLC10 mi · Newington, NH

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Somersworth High School3.0 mi · Somersworth, NH · Community health center
Greater Seacoast Health3.5 mi · Somersworth, NH · Community health center
Mobile Van 13.5 mi · Somersworth, NH · Community health center

Clinics and urgent care

Convenientmd - FFS UC LLC1.8 mi · Dover, NH · Urgent care center
Wentworth Douglass Hospital1.8 mi · Dover, NH · Urgent care center
Convenientmd - FFS UC LLC10 mi · Portsmouth, NH · Urgent care center

Pharmacies

CVS Manchester NH LLC1.8 mi · Dover, NH · Pharmacy
Hannaford Bros Co LLC1.8 mi · Dover, NH · Community/retail pharmacy
Hannaford Bros Co LLC1.8 mi · Dover, NH · Community/retail pharmacy

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Wentworth-Douglass Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	4 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	5 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	4 of 5 stars
Staff explained medicines	3 of 5 stars
Information about recovery at home	5 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Quiet at night	3 of 5 stars
Rated the hospital 9 or 10 out of 10	75%National average: 72%
Would definitely recommend the hospital	81%National average: 71%
Nurses “always” communicated well	80%National average: 80%
Doctors “always” communicated well	80%National average: 80%
Staff “always” explained medicines before giving them	63%National average: 62%
Were given information about recovery at home	91%National average: 86%
Room and bathroom “always” clean	69%National average: 74%
Area around the room “always” quiet at night	53%National average: 60%
Completed surveys	645Response rate: 24%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.62No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.603No different from the national benchmark
Surgical site infections after colon surgery	0No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.353Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	10.2%
Deaths within 30 days: heart failure patients	11.6%
Deaths within 30 days: pneumonia patients	17.3%
Deaths within 30 days: COPD patients	8.1%
Deaths within 30 days: stroke patients	9.2%
Deaths within 30 days: coronary bypass surgery (CABG)	Not reported to Medicare
Serious complications (patient safety indicator PSI-90)	0.75No different from the national rate
Complications after hip or knee replacement	3.5%

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	14.7%
Readmitted within 30 days: heart failure	21.5%
Readmitted within 30 days: pneumonia	18.8%
Readmitted within 30 days: COPD	21%
Readmitted within 30 days: coronary bypass surgery	Not reported to Medicare
Readmitted within 30 days: hip or knee replacement	5.9%

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	242 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	2%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	45%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in New Hampshire

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 49 common services exactly as Wentworth-Douglass Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: Office Visit, Established Pat	$507	$304.20	$58.96 – $392.42
Established patient office visit (about 20–29 minutes): rates for 6 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $73.11 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $58.96 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $269.83 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $318.90 PHCS MULTIPLAN [1022] — HB WDH AMERIHEALTH CARITAS: $73.11 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $58.96
Established patient office visit (about 20–29 minutes) CPT 99213 · Inpatient or outpatient In the file: Office Visit, Established Pat	$507	$304.20	$131.95 – $596.49
Established patient office visit (about 20–29 minutes): rates for 4 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $353.89 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $131.95 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $353.89 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $430.95
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: Office Visit, Established Pat	$781	$468.60	$90.83 – $604.49
Established patient office visit (about 30–39 minutes): rates for 4 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $112.62 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $90.83 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $491.25 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $90.83
Established patient office visit (about 30–39 minutes) CPT 99214 · Inpatient or outpatient In the file: Office Visit, Established Pat	$781	$468.60	$131.95 – $1,003.45
Established patient office visit (about 30–39 minutes): rates for 2 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $545.14 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $131.95
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency Department Visit Low Mdm	$1,220	$732	$141.89 – $944.28
Emergency room visit (moderate): rates for 3 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $175.92 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $944.28 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $141.89
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient In the file: Emergency Department Visit Low Mdm	$1,220	$732	$283.50 – $3,706.98
Emergency room visit (moderate): rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $289.28
Emergency room visit (moderate) CPT 99283 · Inpatient or outpatient · modifier 25 In the file: Emergency Department Visit Low Mdm\|SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME	$1,220	$732	$851.56
Emergency room visit (moderate): rates for 1 insurance plan AETNA [1001] — HB WDH AETNA COMMERCIAL: $851.56
Emergency room visit (moderately high) CPT 99284 · Inpatient or outpatient In the file: Emergency Department Visit Moderate Mdm	$2,190	$1,314	$435.98 – $3,706.98
Emergency room visit (moderately high): rates for 6 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $1,528.62 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $435.98 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $1,528.62 MEDICARE [2001] — HB WDH MEDICARE: $444.88 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $1,861.50 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $444.88
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency Department Visit Moderate Mdm	$2,190	$1,314	$254.70 – $1,695.06
Emergency room visit (moderately high): rates for 1 insurance plan HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $1,592.57
Emergency room visit (high) CPT 99285 · Inpatient or outpatient In the file: Emergency Department Visit High Mdm	$3,237	$1,942.20	$627.73 – $4,093.65
Emergency room visit (high): rates for 9 insurance plans AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $653.35 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $4,093.65 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $1,762.72 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $627.73 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $3,308.86 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $659.76 MEDICARE [2001] — HB WDH MEDICARE: $640.54 TRICARE [160005] — HB WDH MEDICARE: $640.54 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $640.54
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency Department Visit High Mdm	$3,237	$1,942.20	$376.46 – $2,505.44
Emergency room visit (high): rates for 4 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $466.78 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $376.46 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $2,505.44 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $376.46
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · modifier 25 In the file: Emergency Department Visit High Mdm\|SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME	$3,237	$1,942.20	$1,415.22 – $2,353.95
Emergency room visit (high): rates for 4 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $1,415.22 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $2,353.95 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $2,353.95 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $2,353.95

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Basic Metabolic Panel	$120	$72	$7.88 – $92.88
Basic metabolic panel (blood test): rates for 8 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $75.34 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $52.46 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $87.26 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $87.26 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $63.86 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $75.48 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $92.88 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $87.26
Basic metabolic panel (blood test) CPT 80048 · Inpatient or outpatient In the file: Basic Metabolic Panel	$120	$72	$5.50 – $102
Basic metabolic panel (blood test): rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $83.76 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $83.76 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $102
Basic metabolic panel (blood test) CPT 80048 · Inpatient (hospital stay) In the file: Basic Metabolic Panel	$120	$72	$79.44 – $92.23
Basic metabolic panel (blood test): rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $92.23
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Comprehensive Metabolic Panel	$149	$89.40	$9.84 – $115.33
Comprehensive metabolic panel (blood test): rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $93.54 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $65.14 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $108.35 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $108.35 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $79.30 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $93.72 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $108.35 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $115.33 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $108.35
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient or outpatient In the file: Comprehensive Metabolic Panel	$149	$89.40	$6.86 – $126.65
Comprehensive metabolic panel (blood test): rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $104 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $104 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $126.65
Comprehensive metabolic panel (blood test) CPT 80053 · Inpatient (hospital stay) In the file: Comprehensive Metabolic Panel	$149	$89.40	$98.64 – $114.52
Comprehensive metabolic panel (blood test): rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $114.52
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Lipid Panel	$189	$113.40	$12.48 – $146.29
Cholesterol panel (lipid panel): rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $118.65 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $82.63 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $137.44 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $137.44 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $100.59 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $118.88 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $137.44 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $146.29 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $137.44
Cholesterol panel (lipid panel) CPT 80061 · Inpatient or outpatient In the file: Lipid Panel	$189	$113.40	$8.70 – $160.65
Cholesterol panel (lipid panel): rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $131.92 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $131.92 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $160.65
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Renal Function Panel	$123	$73.80	$8.09 – $95.20
Kidney function panel: rates for 5 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $89.45 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $65.46 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $77.37 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $95.20 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $89.45
Kidney function panel CPT 80069 · Inpatient or outpatient In the file: Renal Function Panel	$123	$73.80	$5.64 – $104.55
Kidney function panel: rates for 1 insurance plan AETNA [1001] — HB WDH AETNA COMMERCIAL: $85.85
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Hepatic Function Panel	$116	$69.60	$7.61 – $89.78
Liver function panel: rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $72.82 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $50.72 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $84.36 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $84.36 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $89.78 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $61.74 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $72.96 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $89.78 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $84.36
Liver function panel CPT 80076 · Inpatient or outpatient In the file: Hepatic Function Panel	$116	$69.60	$5.31 – $98.60
Liver function panel: rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $80.97 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $80.97 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $98.60
Liver function panel CPT 80076 · Inpatient (hospital stay) In the file: Hepatic Function Panel	$116	$69.60	$76.79 – $89.16
Liver function panel: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $89.16
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Urinalysis Auto W/Micro	$47	$28.20	$2.95 – $36.38
Urine test (automated, with microscope): rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $29.51 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $20.55 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $34.18 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $34.18 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $25.01 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $29.56 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $34.18 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $36.38 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $34.18
Urine test (automated, with microscope) CPT 81001 · Inpatient or outpatient In the file: Urinalysis Auto W/Micro	$47	$28.20	$2.06 – $39.95
Urine test (automated, with microscope): rates for 2 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $32.81 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $39.95
Urine test (automated, with microscope) CPT 81001 · Inpatient (hospital stay) In the file: Urinalysis Auto W/Micro	$47	$28.20	$31.11 – $36.12
Urine test (automated, with microscope): rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $36.12
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Urinalysis Auto W/O Micro	$33	$19.80	$1.66 – $25.54
Urine test (automated, without microscope): rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $20.72 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $14.43 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $24 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $24 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $25.54 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $17.56 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $20.76 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $25.54 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $24
Urine test (automated, without microscope) CPT 81003 · Inpatient or outpatient In the file: Urinalysis Auto W/O Micro	$33	$19.80	$1.46 – $28.05
Urine test (automated, without microscope): rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $23.03 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $23.03 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $28.05
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Prostatic Specific Antigen Total	$261	$156.60	$13.53 – $202.01
PSA (prostate specific antigen) blood test: rates for 7 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $163.86 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $114.11 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $189.80 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $189.80 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $138.90 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $164.17 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $202.01
PSA (prostate specific antigen) blood test CPT 84153 · Inpatient or outpatient In the file: Prostatic Specific Antigen Total	$261	$156.60	$11.95 – $221.85
PSA (prostate specific antigen) blood test: rates for 2 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $182.18 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $221.85
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Thyroid Stimulating Hormone (Tsh)	$239	$143.40	$15.66 – $184.99
Thyroid stimulating hormone (TSH) test: rates for 8 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $150.04 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $104.49 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $173.80 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $173.80 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $127.20 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $150.33 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $184.99 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $173.80
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient or outpatient In the file: Thyroid Stimulating Hormone (Tsh)	$239	$143.40	$10.92 – $203.15
Thyroid stimulating hormone (TSH) test: rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $166.82 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $166.82 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $203.15
Thyroid stimulating hormone (TSH) test CPT 84443 · Inpatient (hospital stay) In the file: Thyroid Stimulating Hormone (Tsh)	$239	$143.40	$158.22 – $183.70
Thyroid stimulating hormone (TSH) test: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $183.70
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Blood Count Cbc Auto W/Auto Diff	$117	$70.20	$7.24 – $90.56
Complete blood count (CBC) with differential: rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $73.45 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $51.15 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $85.08 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $85.08 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $62.27 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $73.59 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $85.08 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $90.56 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $85.08
Complete blood count (CBC) with differential CPT 85025 · Inpatient or outpatient In the file: Blood Count Cbc Auto W/Auto Diff	$117	$70.20	$5.05 – $99.45
Complete blood count (CBC) with differential: rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $81.67 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $81.67 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $99.45
Complete blood count (CBC) with differential CPT 85025 · Inpatient (hospital stay) In the file: Blood Count Cbc Auto W/Auto Diff	$117	$70.20	$77.45 – $89.93
Complete blood count (CBC) with differential: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $89.93
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Blood Count Cbc Auto W/O Diff	$98	$58.80	$6.03 – $75.85
Complete blood count (CBC), automated: rates for 9 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $61.52 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $42.85 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $71.27 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $71.27 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $52.16 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $61.64 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $71.27 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $75.85 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $71.27
Complete blood count (CBC), automated CPT 85027 · Inpatient or outpatient In the file: Blood Count Cbc Auto W/O Diff	$98	$58.80	$4.21 – $83.30
Complete blood count (CBC), automated: rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $68.40 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $68.40 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $83.30
Complete blood count (CBC), automated CPT 85027 · Inpatient (hospital stay) In the file: Blood Count Cbc Auto W/O Diff	$98	$58.80	$64.88 – $75.32
Complete blood count (CBC), automated: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $75.32
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Prothrombin Time (Pt)	$59	$35.40	$3.65 – $45.67
Blood clotting time test (prothrombin time, PT): rates for 8 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $37.04 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $25.79 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $42.90 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $42.90 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $31.40 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $37.11 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $45.67 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $42.90
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient or outpatient In the file: Prothrombin Time (Pt)	$59	$35.40	$2.79 – $50.15
Blood clotting time test (prothrombin time, PT): rates for 2 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $41.18 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $41.18
Blood clotting time test (prothrombin time, PT) CPT 85610 · Inpatient (hospital stay) In the file: Prothrombin Time (Pt)	$59	$35.40	$39.06 – $45.35
Blood clotting time test (prothrombin time, PT): rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $45.35
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Partial Thromboplastin Time (Ptt)	$92	$55.20	$5.59 – $71.21
Blood clotting test (partial thromboplastin time, PTT): rates for 7 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $57.76 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $40.22 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $66.90 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $66.90 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $57.87 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $71.21 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $66.90
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Inpatient or outpatient In the file: Partial Thromboplastin Time (Ptt)	$92	$55.20	$3.91 – $78.20
Blood clotting test (partial thromboplastin time, PTT): rates for 2 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $64.22 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $64.22

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Inpatient or outpatient In the file: CT Head W/O Contrast	$3,843	$2,305.80	$108.88 – $3,266.55
CT scan of the head or brain, without contrast: 10 of 11 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $710.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $305.75 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $108.88 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $573.93 CHAMPVA [160001] — HB WDH MEDICARE: $111.10 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $2,186.67 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $114.43 MARTIN'S POINT [160007] — HB WDH MEDICARE: $111.10 MEDICARE [2001] — HB WDH MEDICARE: $111.10 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $111.10
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT Head W/O Contrast	$3,843	$2,305.80	$446.94 – $2,974.48
CT scan of the head or brain, without contrast: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $554.16 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $446.94 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $2,417.25 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $2,974.48 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $446.94
MRI of the brain, before and after contrast CPT 70553 · Inpatient or outpatient In the file: MRI Brain W&W/O Cont	$7,879	$4,727.40	$365.65 – $6,697.15
MRI of the brain, before and after contrast: 10 of 14 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $2,384.56 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $1,026.79 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $365.65 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $1,927.41 CHAMPVA [160001] — HB WDH MEDICARE: $373.12 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,483.15 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $384.31 MARTIN'S POINT [160007] — HB WDH MEDICARE: $373.12 MEDICARE [2001] — HB WDH MEDICARE: $373.12 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $6,697.15
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI Brain W&W/O Cont	$7,879	$4,727.40	$916.33 – $6,098.35
MRI of the brain, before and after contrast: rates for 6 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $1,136.15 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $916.33 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $4,193.20 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $4,955.89 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $6,098.35 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $916.33
Chest X-ray, 2 views CPT 71046 · Inpatient or outpatient In the file: Radiologic Exam Chest 2 Views	$581	$348.60	$90.15 – $587.88
Chest X-ray, 2 views: 10 of 16 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $405.54 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $587.88 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $253.14 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $90.15 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $475.18 CHAMPVA [160001] — HB WDH MEDICARE: $91.99 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $405.54 HARVARD PILGRIM [120001] — HB WDH MEDICARE: $91.99 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $94.75 MARTIN'S POINT [160007] — HB WDH MEDICARE: $91.99
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Radiologic Exam Chest 2 Views	$581	$348.60	$67.57 – $449.69
Chest X-ray, 2 views: 10 of 14 insurance plan rates GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $83.78 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $67.57 HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $364.75 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $254.01 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $422.50 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $422.50 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $449.69 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $309.21 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $365.45 PHCS MULTIPLAN [1022] — HB WDH AMERIHEALTH CARITAS: $83.78
Chest X-ray, 2 views CPT 71046 · Inpatient (hospital stay) In the file: Radiologic Exam Chest 2 Views	$581	$348.60	$384.62 – $446.56
Chest X-ray, 2 views: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $446.56
X-ray of the lower spine, at least 4 views CPT 72110 · Inpatient or outpatient In the file: Xr L-Spine 4+ Views	$994	$596.40	$108.88 – $844.90
X-ray of the lower spine, at least 4 views: rates for 10 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $710.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $305.75 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $108.88 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $573.93 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $114.43 MARTIN'S POINT [160007] — HB WDH MEDICARE: $111.10 MEDICARE [2001] — HB WDH MEDICARE: $111.10 TRICARE [160005] — HB WDH MEDICARE: $111.10 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $111.10 WELLSENSE NH [1050] — HB WDH MEDICARE: $111.10
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Xr L-Spine 4+ Views	$994	$596.40	$115.60 – $769.36
X-ray of the lower spine, at least 4 views: rates for 6 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $143.33 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $115.60 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $722.84 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $625.23 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $769.36 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $115.60
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Inpatient or outpatient In the file: MRI L-Spine W/O Cont	$4,499	$2,699.40	$247.49 – $3,824.15
MRI of the lower back (lumbar spine), without contrast: 10 of 13 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $1,613.96 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $694.97 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $247.49 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $1,304.55 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $2,559.93 CIGNA ALTERNATE [1018] — HB WDH CIGNA HMO / PPO / INDEM: $2,559.93 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $260.12 MARTIN'S POINT [160007] — HB WDH MEDICARE: $252.54 MEDICARE [2001] — HB WDH MEDICARE: $252.54 TRICARE [160005] — HB WDH MEDICARE: $252.54
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI L-Spine W/O Cont	$4,499	$2,699.40	$523.23 – $3,482.23
MRI of the lower back (lumbar spine), without contrast: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $648.76 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $523.23 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $2,829.87 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $3,482.23 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $523.23
CT scan of the pelvis, with contrast CPT 72193 · Inpatient or outpatient In the file: CT Pelvis W/Contrast	$6,106	$3,663.60	$182.27 – $5,190.10
CT scan of the pelvis, with contrast: rates for 10 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $1,188.62 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $511.82 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $182.27 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $960.75 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $3,474.31 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $191.57 MARTIN'S POINT [160007] — HB WDH MEDICARE: $185.99 MEDICARE [2001] — HB WDH MEDICARE: $185.99 TRICARE [160005] — HB WDH MEDICARE: $185.99 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $185.99
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT Pelvis W/Contrast	$6,106	$3,663.60	$710.13 – $4,726.04
CT scan of the pelvis, with contrast: rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $4,726.04
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Inpatient or outpatient In the file: MRI Lwr Ext Joint W/O Cont	$5,068	$3,040.80	$247.49 – $4,307.80
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $252.54
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: MRI Lwr Ext Joint W/O Cont	$5,068	$3,040.80	$589.41 – $3,922.63
MRI of a leg joint (such as the knee), without contrast: rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $3,922.63
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient or outpatient In the file: CT Abdomen & Pevis With Contrast	$7,913	$4,747.80	$365.65 – $6,726.05
CT scan of the abdomen and pelvis, with contrast: 10 of 14 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $2,384.56 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $1,026.79 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $365.65 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $1,927.41 CHAMPVA [160001] — HB WDH MEDICARE: $373.12 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,502.50 CIGNA ALTERNATE [1018] — HB WDH CIGNA HMO / PPO / INDEM: $4,502.50 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $384.31 MARTIN'S POINT [160007] — HB WDH MEDICARE: $373.12 MEDICARE [2001] — HB WDH MEDICARE: $373.12
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT Abdomen & Pevis With Contrast	$7,913	$4,747.80	$920.28 – $6,124.66
CT scan of the abdomen and pelvis, with contrast: 10 of 11 insurance plan rates GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $1,141.05 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $920.28 HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $4,967.78 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $3,459.56 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $5,754.33 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $4,211.30 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $4,977.28 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $5,754.33 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $6,124.66 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $5,754.33
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Inpatient (hospital stay) In the file: CT Abdomen & Pevis With Contrast	$7,913	$4,747.80	$5,238.41 – $6,081.93
CT scan of the abdomen and pelvis, with contrast: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $6,081.93
Ultrasound of the abdomen, complete CPT 76700 · Inpatient or outpatient In the file: US Abdomen Cmpl	$1,119	$671.40	$108.88 – $951.15
Ultrasound of the abdomen, complete: 10 of 11 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $710.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $305.75 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $108.88 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $573.93 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $114.43 MARTIN'S POINT [160007] — HB WDH MEDICARE: $111.10 MEDICARE [2001] — HB WDH MEDICARE: $111.10 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $951.15 TRICARE [160005] — HB WDH MEDICARE: $111.10 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $111.10
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US Abdomen Cmpl	$1,119	$671.40	$130.14 – $866.11
Ultrasound of the abdomen, complete: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $161.36 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $130.14 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $703.85 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $866.11 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $130.14
Ultrasound of the abdomen, complete CPT 76700 · Inpatient (hospital stay) In the file: US Abdomen Cmpl	$1,119	$671.40	$740.78 – $860.06
Ultrasound of the abdomen, complete: rates for 1 insurance plan MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $860.06
Pregnancy ultrasound (after the first trimester) CPT 76805 · Inpatient or outpatient In the file: US Pregnancy >14 Weeks Single	$1,248	$748.80	$108.88 – $1,060.80
Pregnancy ultrasound (after the first trimester): rates for 3 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $710.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $305.75 MARTIN'S POINT [160007] — HB WDH MEDICARE: $111.10
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US Pregnancy >14 Weeks Single	$1,248	$748.80	$145.14 – $965.95
Pregnancy ultrasound (after the first trimester): rates for 3 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $179.96 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $145.14 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $145.14
Transvaginal ultrasound CPT 76830 · Inpatient or outpatient In the file: US Transvaginal	$1,204	$722.40	$108.88 – $1,023.40
Transvaginal ultrasound: 10 of 13 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $710.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $305.75 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $108.88 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $573.93 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $114.43 MARTIN'S POINT [160007] — HB WDH MEDICARE: $111.10 MEDICARE [2001] — HB WDH MEDICARE: $111.10 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $757.32 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $1,023.40 TRICARE [160005] — HB WDH MEDICARE: $111.10
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US Transvaginal	$1,204	$722.40	$140.03 – $173.62
Transvaginal ultrasound: rates for 3 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $173.62 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $140.03 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $140.03
Diagnostic mammogram, one breast CPT 77065 · Inpatient or outpatient In the file: Diagnostic Mammography 2d Digital (Incl. Cad)	$1,064	$638.40	$87.88 – $904.40
Diagnostic mammogram, one breast: rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $742.67 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $605.42 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $904.40
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic Mammography 2d Digital (Incl. Cad)	$1,064	$638.40	$123.74 – $823.54
Diagnostic mammogram, one breast: rates for 2 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $773.74 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $823.54
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic Mammo Bilat 2d Digital (Incl. Cad)	$1,353	$811.80	$157.35 – $1,047.22
Diagnostic mammogram, both breasts: rates for 9 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $195.10 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $157.35 HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $849.41 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $591.53 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $983.90 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $720.07 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $851.04 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $1,047.22 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $157.35
Diagnostic mammogram, both breasts CPT 77066 · Inpatient or outpatient In the file: Diagnostic Mammo Bilat 2d Digital (Incl. Cad)	$1,353	$811.80	$111.96 – $1,150.05
Diagnostic mammogram, both breasts: rates for 4 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $944.39 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $769.86 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $944.39 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $1,150.05
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Mammogram Screen Bilat Digital (Incl. Cad)	$1,123	$673.80	$130.60 – $869.20
Screening mammogram, both breasts: 10 of 12 insurance plan rates GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $161.94 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $130.60 HARVARD PILGRIM [120001] — HB WDH HPHC ELEVATE: $705.02 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $490.98 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $816.65 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $816.65 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $597.66 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $706.37 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $816.65 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $869.20
Screening mammogram, both breasts CPT 77067 · Inpatient or outpatient In the file: Mammogram Screen Bilat Digital (Incl. Cad)	$1,123	$673.80	$92.60 – $954.55
Screening mammogram, both breasts: rates for 5 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $783.85 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $638.99 CIGNA ALTERNATE [1018] — HB WDH CIGNA HMO / PPO / INDEM: $638.99 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $783.85 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $954.55

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Inpatient or outpatient In the file: Cath Left Heart W/ Ventriculograpy	$12,769	$7,661.40	$3,293.17 – $21,475.95
Left heart catheterization (diagnostic): rates for 1 insurance plan BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $3,293.17
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: Psg 6 Yrs or Older 4+ Param Lmtd	$7,838	$4,702.80	$1,041.67 – $6,662.30
Sleep study (overnight, in a sleep lab): 10 of 13 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,793.11 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,925.10 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $1,041.67 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $5,490.80 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,459.82 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,094.82 MARTIN'S POINT [160007] — HB WDH MEDICARE: $1,062.93 MEDICARE [2001] — HB WDH MEDICARE: $1,062.93 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $6,662.30 TRICARE [160005] — HB WDH MEDICARE: $1,062.93
Sleep study (overnight, in a sleep lab) CPT 95810 · Inpatient or outpatient In the file: Psg 6 Yrs or Older 4+ Parameters	$7,838	$4,702.80	$1,041.67 – $6,662.30
Sleep study (overnight, in a sleep lab): 10 of 13 insurance plan rates BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,793.11 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,925.10 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $1,041.67 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $5,490.80 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,459.82 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,094.82 MARTIN'S POINT [160007] — HB WDH MEDICARE: $1,062.93 MEDICARE [2001] — HB WDH MEDICARE: $1,062.93 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $6,662.30 TRICARE [160005] — HB WDH MEDICARE: $1,062.93
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Psg 6 Yrs or Older 4+ Param Lmtd	$7,838	$4,702.80	$911.56 – $6,066.61
Sleep study (overnight, in a sleep lab): rates for 8 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $1,130.24 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $911.56 HARVARD PILGRIM [120001] — HB WDH HPHC EXCHANGE: $3,426.77 HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $5,699.79 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $4,930.10 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $6,066.61 UNITED HEALTHCARE ALTERNATE [1020] — HB WDH HPHC HMO POS PPO: $5,699.79 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $911.56

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Ot Exercise Therapeutic 15 Min	$182	$109.20	$21.17 – $140.87
Physical therapy: therapeutic exercise (each 15 minutes): rates for 8 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $132.35 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $132.35 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $140.87 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $96.86 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $114.48 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $132.35 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $140.87 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $21.17
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Pt Exercise Therapeutic 15 Min	$182	$109.20	$21.17 – $140.87
Physical therapy: therapeutic exercise (each 15 minutes): rates for 8 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $132.35 HARVARD PILGRIM ALTERNATE [120002] — HB WDH HPHC HMO POS PPO: $132.35 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $140.87 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $96.86 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $114.48 UNITED HEALTHCARE [1016] — HB WDH HPHC HMO POS PPO: $132.35 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $140.87 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $21.17
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Inpatient or outpatient In the file: Ot Exercise Therapeutic 15 Min	$182	$109.20	$29.13 – $157.54
Physical therapy: therapeutic exercise (each 15 minutes): rates for 4 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $114.19 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $154.70 TRICARE [160005] — HB WDH MEDICARE: $29.13 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $29.13
Physical therapy evaluation (low complexity) CPT 97161 · Inpatient or outpatient In the file: Physical Therapy Evaluation, Low Complexity	$529	$317.40	$99.12 – $456.50
Physical therapy evaluation (low complexity): rates for 6 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $369.24 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $301 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $369.24 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $449.65 TRICARE [160005] — HB WDH MEDICARE: $99.12 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $99.12
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Physical Therapy Evaluation, Low Complexity	$529	$317.40	$61.52 – $409.45
Physical therapy evaluation (low complexity): rates for 6 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $384.69 INTERNATIONAL COMMERCIAL [140001] — HB WDH UNITED HMO / PPO / INDEM: $409.45 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $281.53 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $332.74 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $409.45 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $61.52
Physical therapy evaluation (moderate complexity) CPT 97162 · Inpatient or outpatient In the file: Physical Therapy Evaluation, Moderate Complexity	$519	$311.40	$99.12 – $456.50
Physical therapy evaluation (moderate complexity): rates for 5 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $362.26 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $295.31 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $441.15 TRICARE [160005] — HB WDH MEDICARE: $99.12 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $99.12
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Physical Therapy Evaluation, Moderate Complexity	$519	$311.40	$60.36 – $401.71
Physical therapy evaluation (moderate complexity): rates for 5 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $377.42 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $276.21 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $326.45 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $401.71 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $60.36
Physical therapy evaluation (high complexity) CPT 97163 · Inpatient or outpatient In the file: Physical Therapy Evaluation, High Complexity	$519	$311.40	$99.12 – $456.50
Physical therapy evaluation (high complexity): rates for 3 insurance plans AETNA [1001] — HB WDH AETNA COMMERCIAL: $362.26 PHCS MULTIPLAN [1022] — HB WDH PHCS MULTIPLAN: $441.15 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $99.12
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Physical Therapy Evaluation, High Complexity	$519	$311.40	$60.36 – $401.71
Physical therapy evaluation (high complexity): rates for 3 insurance plans HARVARD PILGRIM [120001] — HB WDH HPHC HMO POS PPO: $377.42 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $326.45 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $60.36

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Upper GI endoscopy (diagnostic) CPT 43235 · Inpatient or outpatient In the file: Egd Flex Dx W/Brushing/Washing	$3,598	$2,158.80	$959.93 – $6,260.06
Upper GI endoscopy (diagnostic): 10 of 12 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $2,511.40 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $999.12 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,260.06 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,695.58 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $959.93 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $5,059.95 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $2,047.26 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,008.91 MARTIN'S POINT [160007] — HB WDH MEDICARE: $979.53 MEDICARE [2001] — HB WDH MEDICARE: $979.53
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Egd Flex Dx W/Brushing/Washing	$3,598	$2,158.80	$418.45 – $2,784.85
Upper GI endoscopy (diagnostic): rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $518.83 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $418.45 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $2,263.14 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $2,784.85 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $418.45
Upper GI endoscopy with biopsy CPT 43239 · Inpatient or outpatient In the file: Egd Flex Transoral W/Biopsy	$5,011	$3,006.60	$959.93 – $6,260.06
Upper GI endoscopy with biopsy: 10 of 16 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $3,497.68 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $999.12 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,260.06 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,695.58 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $959.93 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $5,059.95 CHAMPVA [160001] — HB WDH MEDICARE: $979.53 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $2,851.26 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $3,497.68 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,008.91
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Egd Flex Transoral W/Biopsy	$5,011	$3,006.60	$582.78 – $3,878.51
Upper GI endoscopy with biopsy: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $722.59 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $582.78 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $3,151.92 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $3,878.51 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $582.78
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: Colonoscopy Flexible	$5,344	$3,206.40	$933.47 – $6,087.46
Colonoscopy (diagnostic): 10 of 12 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $3,730.11 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,087.46 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,621.26 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $933.47 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $4,920.44 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $3,040.74 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $981.09 MARTIN'S POINT [160007] — HB WDH MEDICARE: $952.52 MEDICARE [2001] — HB WDH MEDICARE: $952.52 TRICARE [160005] — HB WDH MEDICARE: $952.52
Colonoscopy (diagnostic) CPT 45378 · Inpatient or outpatient In the file: Colonoscopy Flx Dx W/Collj Spec When Pfrmd	$5,344	$3,206.40	$933.47 – $6,087.46
Colonoscopy (diagnostic): 10 of 12 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $3,730.11 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,087.46 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,621.26 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $933.47 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $4,920.44 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $3,040.74 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $981.09 MARTIN'S POINT [160007] — HB WDH MEDICARE: $952.52 MEDICARE [2001] — HB WDH MEDICARE: $952.52 TRICARE [160005] — HB WDH MEDICARE: $952.52
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Colonoscopy Flexible	$5,344	$3,206.40	$621.51 – $4,136.26
Colonoscopy (diagnostic): rates for 6 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $770.60 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $621.51 MGB HEALTH PLAN [150001] — HB WDH MGBHP HMO: $2,844.08 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $3,361.38 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $4,136.26 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $621.51
Colonoscopy with biopsy CPT 45380 · Inpatient or outpatient In the file: Colonoscopy W/Biopsy Single/Multiple	$5,774	$3,464.40	$1,207.22 – $7,872.71
Colonoscopy with biopsy: 10 of 13 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $4,030.25 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $1,256.49 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $7,872.71 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $3,389.98 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $1,207.22 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $6,363.44 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $3,285.41 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,268.81 MARTIN'S POINT [160007] — HB WDH MEDICARE: $1,231.86 MEDICARE [2001] — HB WDH MEDICARE: $1,231.86
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Colonoscopy W/Biopsy Single/Multiple	$5,774	$3,464.40	$671.52 – $4,469.08
Colonoscopy with biopsy: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $832.61 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $671.52 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $3,631.85 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $4,469.08 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $671.52
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: Colonoscopy Flex W/Rem Tumor Snare	$7,092	$4,255.20	$1,207.22 – $7,872.71
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $4,950.22 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $1,256.49 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $7,872.71 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $3,389.98 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $1,207.22 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $6,363.44 CHAMPVA [160001] — HB WDH MEDICARE: $1,231.86 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,035.35 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $4,950.22 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,268.81
Colonoscopy with removal of polyps (snare) CPT 45385 · Inpatient or outpatient In the file: Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq	$7,092	$4,255.20	$1,207.22 – $7,872.71
Colonoscopy with removal of polyps (snare): 10 of 15 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $4,950.22 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $1,256.49 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $7,872.71 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $3,389.98 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $1,207.22 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $6,363.44 CHAMPVA [160001] — HB WDH MEDICARE: $1,231.86 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $4,035.35 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $4,950.22 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,268.81
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Colonoscopy Flex W/Rem Tumor Snare	$7,092	$4,255.20	$824.80 – $5,489.21
Colonoscopy with removal of polyps (snare): rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $1,022.67 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $824.80 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $4,460.87 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $5,489.21 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $824.80
Ultrasound of the lower bowel by endoscope CPT 45391 · Inpatient or outpatient In the file: Colsc Flx W/Ndsc US Xm Rctm Et Al Lmtd&Adj Strux	$7,187	$4,312.20	$1,207.22 – $7,872.71
Ultrasound of the lower bowel by endoscope: rates for 2 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $3,389.98 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $1,268.81
Screening colonoscopy (not high risk) HCPCS G0121 · Inpatient or outpatient In the file: Colon Cancer Scr Non-Hr	$3,079	$1,847.40	$933.47 – $6,087.46
Screening colonoscopy (not high risk): 10 of 13 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $2,149.14 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $971.57 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $6,087.46 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $2,621.26 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $933.47 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $4,920.44 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $1,751.95 COVENTRY FIRST HEALTH [1021] — HB WDH AETNA COMMERCIAL: $2,149.14 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $981.09 MARTIN'S POINT [160007] — HB WDH MEDICARE: $952.52
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: Colon Cancer Scr Non-Hr	$3,079	$1,847.40	$358.09 – $2,383.15
Screening colonoscopy (not high risk): rates for 4 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $443.99 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $358.09 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $2,383.15 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $358.09
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Inpatient or outpatient In the file: Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$4,847	$2,908.20	$709.05 – $4,623.96
Spinal injection, lower back (epidural), with imaging guidance: 10 of 15 insurance plan rates AETNA [1001] — HB WDH AETNA COMMERCIAL: $3,383.21 AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $737.99 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM FEDERAL: $4,623.96 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM HMO: $1,991.07 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $709.05 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $3,737.50 CHAMPVA [160001] — HB WDH MEDICARE: $723.52 CIGNA [1006] — HB WDH CIGNA HMO / PPO / INDEM: $2,757.94 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $745.22 MARTIN'S POINT [160007] — HB WDH MEDICARE: $723.52
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn	$4,847	$2,908.20	$563.71 – $3,751.58
Spinal injection, lower back (epidural), with imaging guidance: rates for 5 insurance plans GENERIC COMMERCIAL [1009] — HB WDH AMERIHEALTH CARITAS: $698.94 GENERIC COMMERCIAL [1009] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $563.71 MGB HEALTH PLAN [150001] — HB WDH MGBHP PPO: $3,048.76 UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $3,751.58 WELLSENSE NH [1050] — HB WDH NH HEALTHY FAMILIES + WELLSENSE: $563.71
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient In the file: Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level	$5,455	$3,273	$911.54 – $5,944.45
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $930.14
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level	$5,455	$3,273	$634.42 – $4,222.17
Nerve root injection, lower back, with imaging guidance: rates for 1 insurance plan UNITED HEALTHCARE [1016] — HB WDH UNITED HMO / PPO / INDEM: $4,222.17
Nerve root injection, lower back, with imaging guidance CPT 64483 · Inpatient or outpatient · modifier 50 In the file: Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level\|BILATERAL PROCEDURE	$5,455	$3,273	$911.54 – $958.04
Nerve root injection, lower back, with imaging guidance: rates for 7 insurance plans AETNA [1001] — HB WDH AETNA MEDICARE REPLACEMENT: $948.74 BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $911.54 HUMANA [1012] — HB WDH HUMANA MEDICARE REPLACEMENT: $958.04 MARTIN'S POINT [160007] — HB WDH MEDICARE: $930.14 MEDICARE [2001] — HB WDH MEDICARE: $930.14 TRICARE [160005] — HB WDH MEDICARE: $930.14 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $930.14

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC	$81,707.20	$49,024.32	$13,775.49 – $73,298.39
Hip or knee replacement (major joint of the leg), without major complications: rates for 4 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM MEDICARE REPLACEMENT + PATHWAYS: $14,807.04 MARTIN'S POINT [160007] — HB WDH MEDICARE: $15,109.22 MEDICARE [2001] — HB WDH MEDICARE: $15,109.22 UNITED HEALTHCARE [1016] — HB WDH MEDICARE: $15,109.22
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC	$67,418.75	$40,451.25	$3,975 – $47,146.72
Uterus and ovary surgery (not for cancer), without complications: rates for 2 insurance plans BLUE CROSS BLUE SHIELD [110001] — HB WDH ANTHEM PPO: $37,550.13 MEDICARE [2001] — HB WDH MEDICARE: $9,877.21

Source: Wentworth-Douglass Hospital’s standard charges file (massgeneralbrigham.org, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on March 27, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	789 Central Ave, Dover, NH 03820
County	Strafford County
State	New Hampshire
Phone	(603) 740‑2580
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	300018
Name in Medicare records	WENTWORTH-DOUGLASS HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(603) 742‑5252^[4]
Official website	massgeneralbrigham.org
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Wentworth-Douglass Hospital — massgeneralbrigham.org
Language Access Services at Mass General Brigham — massgeneralbrigham.org
About Wentworth-Douglass Hospital | Mass General Brigham — massgeneralbrigham.org
Wentworth-Douglass Hospital Nursing | Mass General Brigham — massgeneralbrigham.org
Getting Here and Parking | Mass General Brigham — massgeneralbrigham.org

Wentworth-Douglass Hospital

Summary

Profile from official sources

At a glance