Wentworth Douglass Hospital — price list
← Hospital overviewVerified from Wentworth Douglass Hospital’s published price file
Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
977 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 1 25 Dihydroxy Inc Fraction Inpatient & outpatient | PX-30000412 CDM | $208 | $125 | $25.03 – $199 | $140 | |
| 1 25 Dihydroxy Inc Fraction Outpatient | PX-30000412 CDM | $208 | $125 | $35.87 – $161 | $146 | |
| 3d Echo Img&Pst-Pxessing Tee/Tte Cgen Car Anomal Outpatient | PX-48000480 CDM | $489 | $293 | $56.87 – $378 | $68.06 | |
| Abdominal Paracentesis W/ Imaging Inpatient & outpatient | PX-75000278 CDM | $2,183 | $1,310 | $960 – $6,260 | $1,471 | |
| Abdominal Paracentesis W/ Imaging Outpatient | PX-75000278 CDM | $2,183 | $1,310 | $254 – $1,690 | $304 | |
| Abdominal Paracentesis without Imaging Outpatient | PX-75000277 CDM | $5,456 | $3,274 | $635 – $4,223 | $759 | |
| Ablat Endoven Extrem Laser 1st Inpatient & outpatient | PX-76001070 CDM | $12,148 | $7,289 | $3,223 – $21,016 | $8,182 | |
| Ablat Endoven Extrem Laser 1st Outpatient | PX-76001070 CDM | $12,148 | $7,289 | $1,413 – $9,403 | $10,409 | |
| Ablation Atrioventricular Function Inpatient & outpatient | PX-48000168 CDM | $22,713 | $13,628 | $7,769 – $50,666 | $7,929 | |
| Abortion Induced D&C Inpatient & outpatient | PX-72000030 CDM | $5,375 | $3,225 | $3,058 – $21,230 | $8,919 | |
| Abortion Induced D&C Outpatient | PX-72000030 CDM | $5,375 | $3,225 | $625 – $4,160 | $4,275 | |
| Abortion Induced D&E Inpatient & outpatient | PX-72000031 CDM | $9,349 | $5,609 | $3,255 – $21,230 | $16,989 | |
| Abortion Without D&C Inpatient | 779 MS-DRG | $7,215 | $4,329 | $3,975 – $31,969 | $5,919 | |
| Acetabular augment 20x54 56mm gription tf revision ti truebond locking slot 21 Inpatient & outpatient | SUP-ITM-10118713 CDM | $6,063 | $3,638 | $705 – $5,153 | $3,537 | |
| Acetabular augment 20x54 56mm gription tf revision ti truebond locking slot 21 Outpatient | SUP-ITM-10118713 CDM | $6,063 | $3,638 | $705 – $4,692 | $401 | |
| Acetabular insert 28mm 0deg size d trident polyethylene Inpatient & outpatient | SUP-ITM-10016790 CDM | $3,801 | $2,280 | $442 – $3,230 | $3,537 | |
| Acetabular insert 28mm 0deg size d trident polyethylene Outpatient | SUP-ITM-10016790 CDM | $3,801 | $2,280 | $442 – $2,942 | $401 | |
| Acetabular insert 32mm 10deg trident polyethylene size d Inpatient & outpatient | SUP-ITM-10016632 CDM | $3,801 | $2,280 | $442 – $3,230 | $3,537 | |
| Acetabular insert 32mm 10deg trident polyethylene size d Outpatient | SUP-ITM-10016632 CDM | $3,801 | $2,280 | $442 – $2,942 | $401 | |
| Acetabular insert 32x46 48mm 10deg liner shell eccentric polyethylene Inpatient & outpatient | SUP-ITM-10016847 CDM | $5,293 | $3,176 | $616 – $4,499 | $3,537 | |
| Acetabular insert 32x46 48mm 10deg liner shell eccentric polyethylene Outpatient | SUP-ITM-10016847 CDM | $5,293 | $3,176 | $616 – $4,097 | $401 | |
| Acetabular liner 28x47mm bi-mentum pfrk polyethylene Inpatient & outpatient | SUP-ITM-10282664 CDM | $5,044 | $3,027 | $587 – $4,288 | $3,537 | |
| Acetabular liner 28x47mm bi-mentum pfrk polyethylene Outpatient | SUP-ITM-10282664 CDM | $5,044 | $3,027 | $587 – $3,904 | $401 | |
| Acetabular liner 28x49mm bi mentum altrx Inpatient & outpatient | SUP-ITM-10307545 CDM | $5,044 | $3,027 | $587 – $4,288 | $3,537 | |
| Acetabular liner 28x49mm bi mentum altrx Outpatient | SUP-ITM-10307545 CDM | $5,044 | $3,027 | $587 – $3,904 | $401 | |
| Acetabular liner 32x56mm neutral pinnacle altrx polyethylene Inpatient & outpatient | SUP-ITM-10042881 CDM | $2,412 | $1,447 | $280 – $2,050 | $3,537 | |
| Acetabular liner 32x56mm neutral pinnacle altrx polyethylene Outpatient | SUP-ITM-10042881 CDM | $2,412 | $1,447 | $280 – $1,867 | $401 | |
| Acetabular liner 36x58mm plus 4 10deg pinnacle esc constrained Inpatient & outpatient | SUP-ITM-10020409 CDM | $5,293 | $3,176 | $616 – $4,499 | $3,537 | |
| Acetabular liner 36x58mm plus 4 10deg pinnacle esc constrained Outpatient | SUP-ITM-10020409 CDM | $5,293 | $3,176 | $616 – $4,097 | $401 | |
| Acetabular liner 42mm size e she module dual mobility titanium noncemented Inpatient & outpatient | SUP-ITM-10090958 CDM | $4,837 | $2,902 | $563 – $4,111 | $3,537 |