CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Wentworth-Douglass Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $972
Cash Discount Price: $4,727
vs. Medicare Baseline: 2.73x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Wentworth-Douglass Hospital is $972. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,727. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 2.73x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$4,727

Average discount available for prompt cash payment at this facility.

Insurance Median

$972

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $4,727 (1326%)

Insurance Median: $972 (273%)

Cash: $4,727 (1326% of Medicare)

Ins. Median: $972 (273% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 273% of the Medicare baseline (a markup of 173%). 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	$366 - $2,385	103%
Champva [160001]	$373	105%
Martin's Point [160007]	$373	105%
Medicare (plans)	$373	105%
Tricare	$373	105%
UnitedHealthcare	$373 - $6,098	105%
Wellsense Nh [1050]	$373 - $916	105%
Humana	$384	108%
Generic Commercial [1009]	$916 - $1,136	257%
Wellpoint [1015]	$1,927	541%
Mgb Health Plan [150001]	$4,193 - $4,956	1176%
Cigna	$4,483	1258%
PHCS Multiplan [1022]	$6,697	1879%

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 $4,727.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

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 70553.
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.