Imaging prices at Catholic Medical Center

Manchester, NH · every code in this section with a posted price and a Medicare benchmark.

259 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $1,143 $1,143 10.0×
Acute gi blood loss imaging (78278) $3,196 $3,196 7.3×
Angiography extremity bilateral rs&i (75716) $21,428 $21,428 6.2×
Angiography extremity unilateral rs&i (75710) $7,397 $7,397 2.1×
Angiography pelvic slctv/supraslctv rs&i (75736) $15,347 $15,347 2.5×
Angiography pulmonary bilateral slctv rs&i (75743) $20,226.50 $20,226.50 5.9×
Angiography pulmonary unilateral slctv rs&i (75741) $14,998 $14,998 4.3×
Angiography visceral slctv/supraslctv rs&i (75726) $15,347 $15,347 2.5×
Ankle 2 views (73600) $927.50 $927.50 9.8×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $7,538 $7,538 2.2×
Aortography abdominal serialography rs&i (75625) $17,001 $17,001 4.9×
Aortography Thoracic W/O Serialography Rs&I (75600) $14,959 $14,959 4.3×
Bone &/Joint Imaging Limited Area (78300) $2,829 $2,829 6.5×
Bone &/joint imaging whole body (78306) $3,357 $3,357 7.7×
Bone age studies (77072) $434 $434 3.8×
Bone Imaging 3 Phase (78315) $3,496 $3,496 8.0×
Bone survey infant (77076) $1,049 $1,049 9.2×
Brain Imaging Min 4 Static Views W Vascular Flow (78606) $5,062 $5,062 8.5×
Brain Imaging Pet Metabolic Evaluation (78608) $9,550 $9,550 6.1×
Brain imaging, minimum 4 static views; Non-Facility (78605) $2,948 $2,948 5.0×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $3,587 $3,587 8.2×
Cardiac MRI w/w/o contrast & further seq (75561) $6,913 $6,913 18.1×
Cervical spine 2 or 3 views (72040) $816 $816 8.6×
Chest 1 view (71045) $747 $747 7.9×
Chest xray 3 views (71047) $908 $908 9.6×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $1,086 $1,086 5.7×
Clavicle complete (73000) $572 $572 6.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $2,604 $2,604 22.8×
CT abdomen and pelvis without and with contrast (74178) $8,166 $8,166 21.4×
CT abdomen and pelvis without contrast (74176) $6,211 $6,211 23.8×
CT abdomen w contrast (74160) $3,990 $3,990 20.8×
CT abdomen w wo contrast (74170) $4,081 $4,081 21.3×
CT abdomen w/o contrast (74150) $2,402 $2,402 21.0×
CT angio hrt w/3d image (75574) $2,417 $2,417 6.3×
CT angio lwr extr w/o&w/dye (73706) $2,794 $2,794 14.6×
CT angiography upper extremity lt (73206) $4,102 $4,102 21.4×
CT c-spine w/contrast (72126) $3,763 $3,763 9.9×
CT c-spine w/o contrast (72125) $2,694 $2,694 23.6×
CT chest w contrast (71260) $3,169 $3,169 16.5×
CT chest w/wo contrast (71270) $4,058 $4,058 21.2×
CT colonography screening (74263) $5,019 $5,019 19.3×
CT colonography w/dye (74262) $4,270 $4,270 22.3×
CT colonography w/o cntrst (74261) $1,817 $1,817 15.9×
CT head/brain with contrast (70460) $3,370 $3,370 17.6×
CT head/brain without and with contrast (70470) $3,500 $3,500 18.3×
CT heart contrast eval cardiac structure&morph (75572) $2,417 $2,417 6.3×
CT heart w/o contrast quant eval coronary calcium (75571) $758 $758 8.0×
CT iac w contrast (70481) $3,689 $3,689 19.3×
CT limited/localized follow up study (76380) $1,359 $1,359 14.3×
CT lower ext w/o (73700) $3,129 $3,129 27.4×
CT lower extremity w/contrast material (73701) $3,502 $3,502 18.3×
CT lumbar spine w & w/o contrast (72133) $3,907 $3,907 20.4×
CT lumbar spine w/contrast (72132) $3,907 $3,907 10.3×
CT lumbar spine w/o contrast (72131) $2,984 $2,984 26.1×
CT maxillofacial w contrast (70487) $3,741 $3,741 19.5×
CT maxillofacial w/wo contrast (70488) $2,514 $2,514 13.1×
CT maxillofacial wo contrast (70486) $2,356 $2,356 20.6×
CT orbits w/o contrast (70480) $2,669 $2,669 23.4×
CT pelvis w/o contrast (72192) $2,356 $2,356 20.6×
CT pelvis w/wo contrast (72194) $3,011 $3,011 15.7×
CT soft tissue neck w contrast (70491) $3,140 $3,140 16.4×
CT soft tissue neck w/o & w/contrast material (70492) $828 $828 4.3×
CT soft tissue neck w/o contrast (70490) $2,891 $2,891 25.3×
CT thoracic spine w/o contrast (72128) $2,827 $2,827 24.8×
CT thorax w/o contrast (71250) $2,854 $2,854 25.0×
CT upper ext wo (73200) $3,276 $3,276 28.7×
CT upper extremity with contrast (73201) $3,932 $3,932 10.3×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $4,512 $4,512 23.5×
Cta Abdomen (74175) $3,922 $3,922 20.5×
CTA abdomen pelvis (74174) $7,348 $7,348 19.3×
CTA chest (71275) $5,508 $5,508 28.7×
Cta Head (70496) $3,656 $3,656 19.1×
Cta Neck (70498) $3,554 $3,554 18.5×
Cta Pelvis (72191) $4,660 $4,660 24.3×
Cystography minimum 3 views rs&i (74430) $1,481 $1,481 3.9×
Dxa bone density study 1/> sites axial skel (77080) $942 $942 8.2×
Dxa bone density study 1/>sites appendiclr skel (77081) $621 $621 6.5×
Esophagus (74220) $1,079 $1,079 5.6×
Facial bones min 3 views (70150) $813 $813 7.1×
Fetal biophysical profile non-stress testing (76818) $1,248 $1,248 10.9×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $1,248 $1,248 10.9×
Fluoroscopy up to 1 hr (76000) $961 $961 3.7×
Foot 2 views (73620) $676 $676 7.1×
Forearm 2 views (73090) $572 $572 6.0×
Hand 2 views (73120) $582 $582 5.1×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $4,517 $4,517 7.6×
Hepatobiliary syst imaging including gallbladder (78226) $3,329 $3,329 7.6×
Hysterosalpingogram (74740) $2,794 $2,794 10.7×
Kidney img morphology vascular flow 1 w/rx (78708) $2,942 $2,942 5.0×
Knee 3 views (73562) $1,053 $1,053 11.1×
Lung ventilation imaging (78579) $2,381 $2,381 5.5×
Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) $31,649 $31,649 9.2×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $5,704 $5,704 6.7×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $4,702 $4,702 12.3×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $6,690 $6,690 17.6×
Magnetic Resonance Elastography (76391) $2,788 $2,788 10.7×
Mr safety determination physician/other qhp (76016) $444 $444 4.7×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $124 $124 3.9×
Mr safety implt electronics prepj supvj phys/qhp (76018) $463 $463 4.5×
Mr safety implt pos&/immoblj (76019) $300 $300 4.7×
Mr safety med physics xm customization plng&mntr (76017) $1,219 $1,219 4.7×
MRA head w & w/o contrast (70546) $6,884 $6,884 18.1×
MRA head w/o contrast (70544) $4,687 $4,687 18.0×
MRA head with contrast (70545) $5,704 $5,704 15.0×
MRA neck w contrast (70548) $4,937 $4,937 13.0×
Mra Neck W/O &W/Contrast Material (70549) $6,930 $6,930 18.2×
MRA neck w/o contrast (70547) $4,388 $4,388 16.8×
MRI abdomen w/o & w/contrast material (74183) $7,693 $7,693 20.2×
MRI abdomen w/o contrast (74181) $5,137 $5,137 19.7×
MRI any jt lower extrem w/contrast material (73722) $5,704 $5,704 6.7×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $6,682 $6,682 17.5×
MRI breast w/o contrast bilateral (77047) $2,762 $2,762 10.6×
MRI c-spine with contrast (72142) $5,704 $5,704 15.0×
MRI cardiac w/o contrast (75557) $2,786 $2,786 10.7×
MRI cervical spine w/o contrast (72141) $5,399 $5,399 20.7×
MRI chest w/o & w/contrast material (71552) $7,149 $7,149 18.8×
MRI chest w/o contrast (71550) $4,400 $4,400 16.9×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $4,702 $4,702 12.3×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $6,898 $6,898 18.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $4,467 $4,467 17.1×
MRI orbit face &/neck w/o contrast (70540) $1,222 $1,222 4.7×
MRI orbit/face/neck w&w/o cont (70543) $6,708 $6,708 17.6×
MRI pelvis w/o & w/contrast material (72197) $7,149 $7,149 18.8×
MRI pelvis w/o contrast (72195) $4,694 $4,694 18.0×
MRI spinal canal cervical w/o & w/contr matrl (72156) $7,218 $7,218 18.9×
MRI spinal canal lumbar w/contrast material (72149) $5,704 $5,704 15.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $8,996 $8,996 23.6×
MRI spinal canal thoracic w/contrast matrl (72147) $5,704 $5,704 15.0×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $7,149 $7,149 18.8×
MRI temporomandibular joint (70336) $3,574 $3,574 13.7×
MRI thoracic spine w/o contrast (72146) $4,994 $4,994 19.2×
MRI up ext w/o contrast (73218) $4,467 $4,467 17.1×
MRI upper ext joint w/o contrast (73221) $5,137 $5,137 19.7×
MRI, joint upper extrem combo (73223) $6,349 $6,349 16.7×
Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) $11,584 $11,584 7.4×
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) $12,058 $12,058 5.0×
Myocardial Spect Multiple Studies (78452) $10,372 $10,372 7.3×
Myocardial spect single study at rest or stress (78451) $4,359 $4,359 3.1×
Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) $6,573 $6,573 4.2×
Neck soft tissue (70360) $572 $572 6.0×
Nm gastric emptying study (78264) $3,268 $3,268 7.5×
Nonvascular shunt X-ray (75809) $872 $872 7.6×
Nuclear Rx Oral Admin (79005) $2,372 $2,372 9.3×
Orthopantogram (70355) $573 $573 6.0×
Osseous survey limited (77074) $942 $942 8.2×
Parathyrd planar w/spect&CT (78072) $3,749 $3,749 6.3×
Parathyroid planar imaging w/wo subtraction (78071) $2,829 $2,829 6.5×
Pelvis 1 or 2 views (72170) $488 $488 4.3×
PET image w/CT, skull-thigh (78815) $14,857 $14,857 9.5×
PET imaging for CT attenuation whole body (78816) $14,857 $14,857 9.5×
Pulmonary Perfusion Imaging Particulate (78580) $3,012 $3,012 6.9×
Radex abscess/fistula/sinus tract rs&i (76080) $2,694 $2,694 4.5×
Radex Ankle Compl Minimum 3 Views (73610) $651 $651 6.8×
Radex Calcaneus Minimum 2 Views (73650) $570 $570 6.0×
Radex Elbw Compl Minimum 3 Views (73080) $650 $650 6.8×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $506 $506 5.3×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $707 $707 6.2×
Radex fingr minimum 2 views (73140) $496 $496 5.2×
Radex Foot Compl Minimum 3 Views (73630) $570 $570 6.0×
Radex Hand Minimum 3 Views (73130) $874 $874 9.2×
Radex Hip Unilateral With Pelvis 1 View (73501) $496 $496 5.2×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $1,349 $1,349 11.8×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $1,050 $1,050 9.2×
Radex Humerus Minimum 2 Views (73060) $572 $572 6.0×
Radex Kne 1/2 Views (73560) $702 $702 7.4×
Radex Kne Compl 4/More Views (73564) $1,349 $1,349 11.8×
Radex Mndbl Compl Minimum 4 Views (70110) $730 $730 6.4×
Radex Nasal Bones Complete Minimum 3 Views (70160) $572 $572 6.0×
Radex Sho Compl Minimum 2 Views (73030) $572 $572 6.0×
Radex Sinuses Paransl < 3 Views (70210) $747 $747 7.9×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $650 $650 5.7×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $1,448 $1,448 15.2×
Radex Toe Minimum 2 Views (73660) $570 $570 6.0×
Radex upper extremity infant minimum 2 views (73092) $169 $169 1.5×
Radex Wrst Compl Minimum 3 Views (73110) $572 $572 6.0×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $572 $572 6.0×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $1,716 $1,716 15.0×
Radiologic exam chest 2 views (71046) $999 $999 10.5×
Radiologic exam colon single contrast study (74270) $1,266 $1,266 6.6×
Radiologic Exam Esophagus Double Contrast Study (74221) $1,173 $1,173 6.1×
Radiologic exam upr gi trc double contrast study (74246) $1,532 $1,532 8.0×
Radiologic exam upr gi trc single contrast study (74240) $1,266 $1,266 6.6×
Radiologic examination femur 1 view (73551) $582 $582 6.1×
Radiologic examination tibia & fibula 2 views (73590) $661 $661 7.0×
Radiological examination surgical specimen (76098) $5,961 $5,961 10.0×
Ribs bilateral 3 views (71110) $816 $816 7.1×
Rp loclzj tum plnr whole body single day imaging (78802) $4,132 $4,132 7.0×
Rp loclzj tum spect 1 area single day imaging (78803) $4,114 $4,114 6.9×
Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) $5,208 $5,208 3.7×
Saline Infus Sonohysterography W/Color Doppler (76831) $1,742 $1,742 6.7×
Scapula (73010) $498 $498 4.4×
Screening Digital Breast Tomosynthesis Bi (77063) $174 $174 7.4×
Shoulder 1 view (73020) $517 $517 5.4×
Small bowel series (74250) $1,477 $1,477 7.7×
Thoracolumbar 2 views (72080) $498 $498 5.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $2,784 $2,784 6.4×
Tmj unilateral (70328) $726 $726 7.6×
Ultrasound breast complete (76641) $611 $611 5.3×
Ultrasound Exam Aaa Screen (76706) $1,259 $1,259 11.0×
Ultrasound, abdomen limited (76705) $1,399.50 $1,399.50 12.3×
Umbilical-artery Doppler (OB) (76820) $864 $864 7.6×
Urethrocystogram voiding (74455) $1,666 $1,666 6.4×
Us breast unilateral limited (76642) $438 $438 4.6×
Us chest (76604) $890 $890 7.8×
Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) $3,051 $3,051 12.9×
Us compl joint r-t w/image documentation (76881) $1,014 $1,014 8.9×
Us elastography parenchyma (76981) $984 $984 8.6×
Us encephalogram (76506) $939 $939 8.2×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $960 $960 8.4×
Us ob limited (76815) $1,081 $1,081 9.5×
Us ob transvaginal (76817) $1,172 $1,172 10.3×
Us pelvic non ob complete (76856) $1,657 $1,657 14.5×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $1,031 $1,031 9.0×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,729 $1,729 15.1×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $940 $940 8.2×
Us retroperitoneal complete (76770) $1,391 $1,391 12.2×
Us retroperitoneal limited (76775) $1,323 $1,323 11.6×
Us scrotum and contents (76870) $1,439 $1,439 12.6×
Us soft tissue head/neck (76536) $1,439 $1,439 12.6×
Us spinal canal and contents (76800) $942 $942 8.2×
Venogram extremity bilateral (75822) $8,839.50 $8,839.50 5.1×
Venogram Extremity Unilateral (75820) $4,803 $4,803 2.8×
Venography caval inferior serialography rs&i (75825) $6,210 $6,210 1.8×
Venography caval superior serialography rs&i (75827) $5,461 $5,461 3.2×
Venography renal unilateral selective rs&i (75831) $4,942 $4,942 1.4×
Venography venous sinus/jugular cath rs&i (75860) $7,303 $7,303 2.1×
Wrist 2 views (73100) $582 $582 6.1×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $853 $853 7.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $1,270 $1,270 13.4×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $656 $656 6.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $572 $572 6.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $816 $816 7.1×
X-ray exam of femur 2/> (73552) $747 $747 7.9×
X-ray eye for foreign body (70030) $572 $572 6.0×
X-ray IV pyelogram (ivp) (74400) $1,276 $1,276 6.7×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $611 $611 6.4×
X-ray leg, infant (73592) $498 $498 5.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $790 $790 6.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $942 $942 8.2×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $784 $784 6.9×
X-ray retrograde pyelogram (74420) $2,850 $2,850 7.5×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $617 $617 6.5×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $772 $772 6.8×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $942 $942 8.2×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $488 $488 4.3×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $572 $572 6.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $676 $676 7.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $588 $588 5.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $636 $636 5.6×
X-Ray Spine One View - Xr Spine (72020) $570 $570 6.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $550 $550 5.8×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $676 $676 7.1×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $704 $704 6.2×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $707 $707 6.2×
Xr bone length studies (77073) $766 $766 6.7×
Xr c-spine 4 or 5 views (72050) $942 $942 8.2×
Xr c-spine 6 or more views (72052) $942 $942 8.2×
Xr chest 4+ views (71048) $927 $927 8.1×
Xr urogram antegrade (74425) $1,674 $1,674 4.4×