Imaging prices at Alice Peck Day Memorial Hospital
Lebanon, NH · every code in this section with a posted price and a Medicare benchmark.
190 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $152 | $282 | 1.6× |
| Abdomen 2 views (74019) | $205.90 | $382 | 1.8× |
| Ankle 2 views (73600) | $215.60 | $400 | 2.3× |
| Arthrogram hip (73525) | $423.65 | $786 | 1.1× |
| Bone age studies (77072) | $87.86 | $163 | 0.8× |
| Cat Scan Follow-Up Study (76380) | $542.77 | $1,007 | 5.8× |
| Chest 1 view (71045) | $148.22 | $275 | 1.6× |
| Chest 2 views (71046) | $152 | $282 | 1.6× |
| Chest 3 views (71047) | $150.92 | $280 | 1.6× |
| Chest 4 or more views (71048) | $205.90 | $382 | 1.8× |
| Clavicle complete (73000) | $218.29 | $405 | 2.3× |
| CT abdomen and pelvis without and with contrast (74178) | $1,521.06 | $2,822 | 4.1× |
| CT abdomen and pelvis without contrast (74176) | $1,141.60 | $2,118 | 4.5× |
| CT abdomen w contrast (74160) | $1,141.60 | $2,118 | 6.1× |
| CT abdomen w wo contrast (74170) | $1,065.60 | $1,977 | 5.7× |
| CT abdomen w/o contrast (74150) | $744.36 | $1,381 | 6.7× |
| CT Angio Abdomen and Pelvis (74174) | $2,717.64 | $5,042 | 7.3× |
| CT Angio Chest (71275) | $1,521.06 | $2,822 | 8.1× |
| CT Angio Head (70496) | $1,743.66 | $3,235 | 9.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,526.99 | $2,833 | 8.2× |
| CT Angio Neck (70498) | $1,814.81 | $3,367 | 9.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,790.56 | $3,322 | 9.6× |
| CT cervical spine w/ contrast (72126) | $1,442.36 | $2,676 | 3.9× |
| CT cervical spine w/o contrast (72125) | $950.26 | $1,763 | 8.5× |
| CT chest w contrast (71260) | $1,141.60 | $2,118 | 6.1× |
| CT chest w/wo contrast (71270) | $1,141.60 | $2,118 | 6.1× |
| CT head/brain with contrast (70460) | $989.60 | $1,836 | 5.3× |
| CT head/brain without and with contrast (70470) | $1,141.60 | $2,118 | 6.1× |
| CT iac w contrast (70481) | $989.60 | $1,836 | 5.3× |
| CT l-spine w&w/o contrast (72133) | $1,932.85 | $3,586 | 10.3× |
| CT lower ext w/o (73700) | $907.14 | $1,683 | 8.1× |
| CT lower extremity w/contrast material (73701) | $1,360.97 | $2,525 | 7.3× |
| CT lumbar spine w contrast (72132) | $1,217.06 | $2,258 | 3.3× |
| CT lumbar spine w/o contrast (72131) | $1,141.60 | $2,118 | 10.2× |
| CT maxillofacial w contrast (70487) | $1,141.60 | $2,118 | 6.1× |
| CT maxillofacial wo contrast (70486) | $1,141.60 | $2,118 | 10.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $2,644.33 | $4,906 | 14.1× |
| CT orbits w/o contrast (70480) | $912.53 | $1,693 | 8.2× |
| CT pelvis w&w/o contrast (72194) | $1,297.91 | $2,408 | 6.9× |
| CT pelvis w/o contrast (72192) | $936.78 | $1,738 | 8.4× |
| CT scan of leg combo (73702) | $1,442.36 | $2,676 | 7.7× |
| CT soft tissue neck w contrast (70491) | $989.60 | $1,836 | 5.3× |
| CT soft tissue neck w/o contrast (70490) | $912.53 | $1,693 | 8.2× |
| CT thoracic spine w contrast (72129) | $1,442.36 | $2,676 | 7.7× |
| CT thoracic spine w/o contrast (72128) | $950.26 | $1,763 | 8.5× |
| CT thorax w/o contrast (71250) | $761.61 | $1,413 | 6.8× |
| CT upper ext wo (73200) | $985.29 | $1,828 | 8.8× |
| CT upper extremity with contrast (73201) | $897.97 | $1,666 | 2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) | $380.53 | $706 | 2.0× |
| Cta Abdomen (74175) | $1,521.06 | $2,822 | 8.1× |
| CTA pelvis (72191) | $1,597.06 | $2,963 | 8.5× |
| Dxa Bone Density Axial (77080) | $362.75 | $673 | 3.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) | $229.07 | $425 | 2.5× |
| Echo exam uterus (76831) range across 2 matching MRF lines |
$40.42–$478.63 | $75–$888 | varies |
| Esophagram (74220) | $372.99 | $692 | 2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) | $328.79 | $610 | 2.9× |
| Foot 2 views (73620) | $182.72 | $339 | 2.0× |
| Forearm 2 views (73090) | $242.55 | $450 | 2.6× |
| Hand 2 views (73120) | $184.34 | $342 | 1.7× |
| Hysterosalpingogram (74740) | $375.68 | $697 | 1.5× |
| Knee 3 Views (73562) | $322.86 | $599 | 3.5× |
| Mra Head W/O & W/Contrast Material (70546) | $2,662.12 | $4,939 | 7.1× |
| MRA head w/o contrast (70544) | $1,521.06 | $2,822 | 6.0× |
| MRA neck w contrast (70548) | $2,815.20 | $5,223 | 7.6× |
| Mra Neck W/O &W/Contrast Material (70549) | $2,815.20 | $5,223 | 7.6× |
| MRA neck w/o contrast (70547) | $1,736.66 | $3,222 | 6.8× |
| MRI abdomen w/o contrast (74181) | $1,716.18 | $3,184 | 6.7× |
| MRI any jt lower extrem w/contrast material (73722) | $1,802.95 | $3,345 | 2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $3,335.33 | $6,188 | 9.0× |
| MRI any jt upper extremity w/contrast matrl (73222) | $1,647.72 | $3,057 | 2.0× |
| MRI cervical spine w contrast (72142) | $1,959.80 | $3,636 | 5.3× |
| MRI cervical spine w/o cont (72141) | $1,521.06 | $2,822 | 6.0× |
| MRI chest w/o contrast (71550) | $59.29 | $110 | 0.2× |
| MRI chest wo w contrast (71552) | $3,119.19 | $5,787 | 8.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $2,048.74 | $3,801 | 5.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $3,789.71 | $7,031 | 10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) | $1,562.02 | $2,898 | 6.1× |
| MRI lumbar spine w contrast (72149) | $2,018.55 | $3,745 | 5.4× |
| Mri Neck Spine W/O & W/Dye (72156) | $3,233.46 | $5,999 | 8.7× |
| MRI orbit face &/neck w/o contrast (70540) | $3,043.19 | $5,646 | 11.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) | $3,043.19 | $5,646 | 8.2× |
| MRI pelvis w/o & w contrast (72197) | $3,166.09 | $5,874 | 8.5× |
| MRI pelvis w/o contrast (72195) | $1,554.48 | $2,884 | 6.1× |
| MRI thoracic spine w/o contrast (72146) | $1,635.33 | $3,034 | 6.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,550.16 | $2,876 | 6.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $3,789.71 | $7,031 | 10.2× |
| MRI, abdomen, combo (74183) | $3,119.19 | $5,787 | 8.4× |
| MRI, dorsal spine combo (72157) | $3,233.46 | $5,999 | 8.7× |
| MRI, joint upper extrem (73221) | $1,550.16 | $2,876 | 6.1× |
| MRI, joint upper extrem combo (73223) | $3,121.89 | $5,792 | 8.4× |
| MRI, lumbar spine combo (72158) | $3,233.46 | $5,999 | 8.7× |
| Myelogram Lumbar (72265) | $557.33 | $1,034 | 0.7× |
| Neck soft tissue (70360) | $152 | $282 | 1.6× |
| Ob us nuchal meas 1 gest (76813) | $62.52 | $116 | 0.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$23.72–$35.03 | $44–$65 | varies |
| Pelvis 1 or 2 views (72170) | $131.52 | $244 | 1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $228.54 | $424 | 2.0× |
| Radex Ankle Complete Minimum 3 Views (73610) | $242.55 | $450 | 2.6× |
| Radex Calcaneus Minimum 2 Views (73650) | $218.29 | $405 | 2.3× |
| Radex elbow complete minimum 3 views (73080) | $218.29 | $405 | 2.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $376.22 | $698 | 3.4× |
| Radex fingr minimum 2 views (73140) | $161.70 | $300 | 1.7× |
| Radex foot complete minimum 3 views (73630) | $218.29 | $405 | 2.3× |
| Radex Hand Minimum 3 Views (73130) | $269.50 | $500 | 2.9× |
| Radex lower extremity infant minimum 2 views (73592) | $274.35 | $509 | 3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $269.50 | $500 | 2.9× |
| Radex Ribs Unilateral 2 Views (71100) | $242.55 | $450 | 2.6× |
| Radex shoulder complete minimum 2 views (73030) | $269.50 | $500 | 2.9× |
| Radex Spine 1 View Specify Level (72020) | $137.98 | $256 | 1.5× |
| Radex Sternum Minimum 2 Views (71120) | $178.41 | $331 | 1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $341.19 | $633 | 3.7× |
| Radex Toe Minimum 2 Views (73660) | $173.56 | $322 | 1.9× |
| Radex upper extremity infant minimum 2 views (73092) | $242.55 | $450 | 2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) | $272.73 | $506 | 2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) | $178.41 | $331 | 1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $88.93 | $165 | 0.8× |
| Radiologic exam colon single contrast study (74270) | $485.10 | $900 | 2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) | $420.96 | $781 | 2.2× |
| Radiologic exam knee complete 4/more views (73564) | $349.81 | $649 | 3.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) | $218.29 | $405 | 2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $480.79 | $892 | 2.6× |
| Radiologic exam swallow function contrast study (74230) | $447.37 | $830 | 2.4× |
| Radiologic exam upr gi trc double contrast study (74246) | $524.45 | $973 | 2.8× |
| Radiologic examination femur minimum 2 views (73552) | $218.29 | $405 | 2.3× |
| Radiologic examination knee 1/2 views (73560) | $295.37 | $548 | 3.2× |
| Radiologic examination tibia & fibula 2 views (73590) | $178.41 | $331 | 1.9× |
| Ribs bilateral 3 views (71110) | $299.68 | $556 | 2.7× |
| Scapula (73010) | $218.29 | $405 | 2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) | $122.35 | $227 | 5.2× |
| Shoulder 1 view (73020) | $215.60 | $400 | 2.3× |
| Shoulder Arthrography (73040) | $384.85 | $714 | 1.0× |
| Skull less than 4 views (70250) | $222.07 | $412 | 2.0× |
| Sternoclavicular joints (71130) | $218.29 | $405 | 2.3× |
| Tbs technical calculation only (77091) | $19.40 | $36 | 0.2× |
| Thoracic spine 2 views (72070) | $239.32 | $444 | 2.1× |
| Thoracic spine 3 views (72072) | $344.96 | $640 | 3.1× |
| Thoracolumbar 2 views (72080) | $239.32 | $444 | 2.6× |
| Ultrasound Breast Limited (76642) | $312.62 | $580 | 3.4× |
| Ultrasound Exam Aaa Screen (76706) | $303.46 | $563 | 2.7× |
| Ultrasound, abdomen limited (76705) range across 2 matching MRF lines |
$32.88–$358.43 | $61–$665 | varies |
| Umbilical-artery Doppler (OB) (76820) | $246.86 | $458 | 2.2× |
| Unlisted Dx Radiographic Procedure (76499) | $258.18 | $479 | 2.8× |
| Upper gi w/o kub (74240) | $342.80 | $636 | 1.8× |
| Us breast unilateral complete (76641) | $409.64 | $760 | 3.7× |
| Us chest (76604) range across 2 matching MRF lines |
$32.34–$358.43 | $60–$665 | varies |
| Us complete joint (76881) range across 2 matching MRF lines |
$77.08–$408.02 | $143–$757 | varies |
| Us exam, pelvic, limited (76857) range across 2 matching MRF lines |
$53.36–$280.28 | $99–$520 | varies |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 2 matching MRF lines |
$73.30–$268.96 | $136–$499 | varies |
| Us ob limited 1 or more fetuses (76815) range across 2 matching MRF lines |
$36.65–$300.22 | $68–$557 | varies |
| Us ob transvaginal (76817) range across 2 matching MRF lines |
$77.62–$298.07 | $144–$553 | varies |
| Us pelvic non ob complete (76856) | $501.81 | $931 | 4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $426.35 | $791 | 3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) | $416.65 | $773 | 3.7× |
| Us retroperitoneal complete (76770) | $430.12 | $798 | 3.9× |
| Us retroperitoneal limited (76775) range across 2 matching MRF lines |
$32.34–$269.50 | $60–$500 | varies |
| Us scrotum and contents (76870) range across 2 matching MRF lines |
$87.86–$495.34 | $163–$919 | varies |
| Us spinal canal and contents (76800) | $472.70 | $877 | 4.2× |
| Us thyroid (76536) range across 2 matching MRF lines |
$31.80–$510.43 | $59–$947 | varies |
| Wrist 2 views (73100) | $230.69 | $428 | 2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $269.50 | $500 | 2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $191.34 | $355 | 2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $298.07 | $553 | 3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $372.45 | $691 | 3.3× |
| X-Ray Exam Hip Uni 1 View (73501) | $164.93 | $306 | 1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $178.41 | $331 | 1.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $356.28 | $661 | 3.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $288.36 | $535 | 2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $356.28 | $661 | 3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $437.13 | $811 | 3.9× |
| X-Ray Exam L-S Spine Bending (72114) | $384.31 | $713 | 3.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $256.02 | $475 | 2.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $384.31 | $713 | 3.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $299.68 | $556 | 2.7× |
| X-ray eye for foreign body (70030) | $111.57 | $207 | 1.2× |
| X-ray humerus (73060) | $178.41 | $331 | 1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $230.69 | $428 | 2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) | $318.55 | $591 | 3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $298.07 | $553 | 2.7× |
| X-ray nose-rectum child f.b. (76010) | $6.47 | $12 | 0.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $384.85 | $714 | 3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $170.32 | $316 | 1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $239.32 | $444 | 2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $292.14 | $542 | 3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $323.40 | $600 | 2.9× |
| X-ray thoracic spine 4 vw (72074) | $449.53 | $834 | 4.0× |
| X-Rays Bone Length Studies (77073) | $256.02 | $475 | 2.3× |
| X-Rays Bone Survey Complete (77075) | $558.40 | $1,036 | 5.0× |
| Xr c-spine 4 or 5 views (72050) | $384.31 | $713 | 3.4× |
| Xr facial bones less than 3 views (70140) | $269.50 | $500 | 2.9× |
| Xr orbits complete 4 views (70200) | $292.14 | $542 | 2.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.