CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Wentworth-Douglass Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $1,108
Cash Discount Price: $4,612
vs. Medicare Baseline: 4.55x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Wentworth-Douglass Hospital is $1,108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,612. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.55x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$4,612

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,108

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $4,612 (1892%)

Insurance Median: $1,108 (455%)

Cash: $4,612 (1892% of Medicare)

Ins. Median: $1,108 (455% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 455% of the Medicare baseline (a markup of 355%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$247 - $1,614	101%
Martin's Point [160007]	$253	104%
Medicare (plans)	$253	104%
Tricare	$253	104%
UnitedHealthcare	$253 - $5,950	104%
Wellsense Nh [1050]	$253 - $894	104%
Humana	$260	107%
Generic Commercial [1009]	$894 - $1,108	367%
Harvard Pilgrim [120001]	$3,361 - $5,590	1379%
Cigna	$4,374	1794%
Mgb Health Plan [150001]	$4,835	1983%
Harvard Pilgrim Alternate [120002]	$5,590	2293%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $4,612.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Wentworth-Douglass Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.