Home › Hospitals › MaineHealth Memorial Hospital Posts prices for 34 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-28.
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Procedure Cash price Gross charge × Medicare
Epidural injection, lumbar/sacral (with imaging) (62322) $1,594.70
$1,594.70
1.7×
CT head/brain without contrast (70450) $1,728.30
$1,728.30
15.5×
MRI brain without contrast (70551) $3,932.90
$3,932.90
15.4×
MRI brain with contrast (70552) $4,713.95
$4,713.95
12.7×
MRI brain without and with contrast (70553) $5,592.10
$5,592.10
15.0×
X-ray lower spine, 4+ views (72110) $485.40
$485.40
4.3×
MRI lumbar spine without contrast (72148) $4,362
$4,362
17.1×
CT pelvis with contrast (72193) $2,400.80
$2,400.80
12.8×
MRI lower-extremity joint without contrast (73721) $3,614.95
$3,614.95
14.2×
CT abdomen and pelvis with contrast (74177) $2,276.70
$2,276.70
6.1×
Ultrasound, abdomen complete (76700) $1,040.15
$1,040.15
9.3×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $611
$611
5.5×
Ultrasound, transvaginal (76830) $915.80
$915.80
8.2×
Mammography, one breast (diagnostic) (77065) $854.40
$854.40
9.9×
Mammography, both breasts (diagnostic) (77066) $1,021.80
$1,021.80
9.2×
Mammography, screening (bilateral) (77067) $1,036.15
$1,036.15
11.4×
Basic metabolic panel (80048) $106
$106
12.5×
Comprehensive metabolic panel (80053) $134.75
$134.75
12.8×
Lipid panel (80061) $170.15
$170.15
12.7×
Renal function panel (80069) $109.90
$109.90
12.7×
Hepatic function panel (80076) $103.45
$103.45
12.7×
Urinalysis, non-automated, with microscopy (81000) $32.45
$32.45
8.1×
Urinalysis, non-automated, without microscopy (81002) $24.55
$24.55
7.1×
PSA, total (84153) $182.30
$182.30
9.9×
Thyroid stimulating hormone (TSH) (84443) $210.65
$210.65
12.5×
CBC with automated differential (85025) $95.50
$95.50
12.3×
CBC, automated (85027) $81.10
$81.10
12.5×
Prothrombin time (PT) (85610) $50.40
$50.40
11.7×
Partial thromboplastin time (PTT) (85730) $75.90
$75.90
12.6×
Sleep study (attended polysomnography) (95810) $3,137.35
$3,137.35
3.4×
Physical therapy, therapeutic exercise (per 15 min) (97110) $102.10
$102.10
3.5×
Office visit, new patient (low complexity, ~30 min) (99203) $78.50
$78.50
0.6×
Office visit, new patient (moderate complexity, ~45 min) (99204) $120.45
$120.45
0.8×
Office visit, new patient (high complexity, ~60 min) (99205) $150.50
$150.50
1.1×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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