Imaging prices at MaineHealth Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $331 $331 3.0×
Ankle 2 views (73600) $256.45 $256.45 2.8×
Arthrogram ankle (73615) $775.80 $775.80 2.1×
Arthrogram elbow (73085) $1,108.15 $1,108.15 3.0×
Arthrogram hip (73525) $1,108.15 $1,108.15 3.0×
Arthrogram knee (73580) $1,377.70 $1,377.70 3.7×
Arthrogram shoulder (73040) $1,108.15 $1,108.15 3.0×
Arthrogram wrist (73115) $839.95 $839.95 2.3×
Bone &/Joint Imaging Limited Area (78300) $1,961.20 $1,961.20 4.6×
Bone &/Joint Imaging Multiple Areas (78305) $2,400.80 $2,400.80 5.6×
Bone &/joint imaging whole body (78306) $2,799.85 $2,799.85 6.6×
Bone age studies (77072) $298.25 $298.25 2.7×
Bone Imaging 3 Phase (78315) $3,137.35 $3,137.35 7.3×
Bone survey complete (77075) $829.50 $829.50 7.4×
Bone survey infant (77076) $514.10 $514.10 4.6×
Bowel imaging (78290) $2,000.45 $2,000.45 4.7×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $3,624.15 $3,624.15 8.5×
Cervical spine 2 or 3 views (72040) $321.85 $321.85 3.5×
Chest 1 view (71045) $246 $246 2.6×
Chest xray 3 views (71047) $392.45 $392.45 4.2×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $689.50 $689.50 3.7×
Clavicle complete (73000) $269.50 $269.50 2.9×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $2,107.70 $2,107.70 18.9×
CT abdomen and pelvis without and with contrast (74178) $2,925.40 $2,925.40 7.9×
CT abdomen and pelvis without contrast (74176) $1,208.90 $1,208.90 4.7×
CT abdomen w contrast (74160) $2,400.80 $2,400.80 12.8×
CT abdomen w wo contrast (74170) $2,973.85 $2,973.85 15.9×
CT abdomen w/o contrast (74150) $1,987.35 $1,987.35 17.8×
CT angio lwr extr w/o&w/dye (73706) $3,783.70 $3,783.70 20.2×
CT angiography upper extremity lt (73206) $3,783.70 $3,783.70 20.2×
CT c-spine w/o contrast (72125) $2,107.70 $2,107.70 18.9×
CT chest w contrast (71260) $2,481.90 $2,481.90 13.3×
CT chest w/wo contrast (71270) $3,104.70 $3,104.70 16.6×
CT head/brain with contrast (70460) $1,987.35 $1,987.35 10.6×
CT head/brain without and with contrast (70470) $2,481.90 $2,481.90 13.3×
CT heart w/o contrast quant eval coronary calcium (75571) $225.10 $225.10 2.4×
CT iac w contrast (70481) $1,987.35 $1,987.35 10.6×
CT limited/localized follow up study (76380) $1,279.55 $1,279.55 13.8×
CT lower ext w/o (73700) $2,599.70 $2,599.70 23.3×
CT lower extremity w wo contrast (73702) $3,410.90 $3,410.90 18.2×
CT lower extremity w/contrast material (73701) $2,716.15 $2,716.15 14.5×
CT lumbar spine w & w/o contrast (72133) $3,104.70 $3,104.70 16.6×
CT lumbar spine w/contrast (72132) $2,481.90 $2,481.90 6.7×
CT lumbar spine w/o contrast (72131) $2,107.70 $2,107.70 18.9×
CT maxillofacial w contrast (70487) $1,987.35 $1,987.35 10.6×
CT maxillofacial w/wo contrast (70488) $2,481.90 $2,481.90 13.3×
CT maxillofacial wo contrast (70486) $1,728.30 $1,728.30 15.5×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,481.90 $2,481.90 13.3×
CT orbits w/o contrast (70480) $1,728.30 $1,728.30 15.5×
CT pelvis w/o contrast (72192) $2,107.70 $2,107.70 18.9×
CT pelvis w/wo contrast (72194) $2,973.85 $2,973.85 15.9×
CT scan of arm combo (73202) $3,410.90 $3,410.90 18.2×
CT soft tissue neck w contrast (70491) $1,987.35 $1,987.35 10.6×
CT soft tissue neck w/o & w/contrast material (70492) $2,481.90 $2,481.90 13.3×
CT soft tissue neck w/o contrast (70490) $1,728.30 $1,728.30 15.5×
CT thoracic spine w/contrast (72129) $2,481.90 $2,481.90 13.3×
CT thoracic spine w/o contrast (72128) $2,107.70 $2,107.70 18.9×
CT thorax w/o contrast (71250) $2,107.70 $2,107.70 18.9×
CT upper ext wo (73200) $2,599.70 $2,599.70 23.3×
CT upper extremity with contrast (73201) $2,716.15 $2,716.15 7.3×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $5,433.55 $5,433.55 29.0×
Cta Abdomen (74175) $4,139.55 $4,139.55 22.1×
CTA abdomen pelvis (74174) $4,017.95 $4,017.95 10.8×
CTA chest (71275) $4,260 $4,260 22.7×
Cta Head (70496) $3,727.40 $3,727.40 19.9×
Cta Neck (70498) $3,727.40 $3,727.40 19.9×
Cta Pelvis (72191) $2,105.20 $2,105.20 11.2×
Cystography minimum 3 views rs&i (74430) $554.80 $554.80 1.5×
Doppler Fetal Mid Cerebral Artery (76821) $654.20 $654.20 5.9×
Dxa bone density study 1/> sites axial skel (77080) $1,000.90 $1,000.90 9.0×
Dxa bone density study axial skeleton (77085) $529.90 $529.90 4.7×
Esophagus (74220) $625.40 $625.40 3.3×
Facial bones min 3 views (70150) $413.50 $413.50 3.7×
Fetal biophysical profile non-stress testing (76818) $855.65 $855.65 7.7×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $855.65 $855.65 7.7×
Fluoroscopy up to 1 hr (76000) $696.05 $696.05 2.7×
Foot 2 views (73620) $277.35 $277.35 3.0×
Forearm 2 views (73090) $269.50 $269.50 2.9×
Hand 2 views (73120) $256.45 $256.45 2.3×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $3,863.55 $3,863.55 6.7×
Hepatobiliary syst imaging including gallbladder (78226) $1,894 $1,894 4.4×
Hysterosalpingogram (74740) $689.50 $689.50 2.7×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $2,093.35 $2,093.35 3.6×
Kidney img morphology vascular flow 1 w/rx (78708) $2,931.95 $2,931.95 5.1×
Kidney Img Morphology Vascular Flow Multiple (78709) $2,931.95 $2,931.95 5.1×
Knee 3 views (73562) $304.90 $304.90 3.3×
Lung perf&ventilat diferentl (78598) $2,385.10 $2,385.10 4.1×
Lung perfusion differential (78597) $1,589.65 $1,589.65 3.7×
Lung ventilation imaging (78579) $2,493.70 $2,493.70 5.8×
Lymphoscintigraphy (78195) $2,676.85 $2,676.85 4.6×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $3,989.15 $3,989.15 4.8×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $3,989.15 $3,989.15 10.7×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $6,736.70 $6,736.70 18.1×
Mr safety determination physician/other qhp (76016) $176.10 $176.10 1.9×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $49 $49 1.6×
Mr safety implt electronics prepj supvj phys/qhp (76018) $183.60 $183.60 1.8×
Mr safety implt pos&/immoblj (76019) $118.80 $118.80 1.9×
Mr safety med physics xm customization plng&mntr (76017) $483.45 $483.45 1.9×
MRA head w/o contrast (70544) $3,932.90 $3,932.90 15.4×
Mra Neck W/O &W/Contrast Material (70549) $7,666.90 $7,666.90 20.6×
MRA neck w/o contrast (70547) $3,932.90 $3,932.90 15.4×
MRI abdomen w contrast (74182) $4,655.10 $4,655.10 12.5×
MRI abdomen w/o & w/contrast material (74183) $8,602.30 $8,602.30 23.1×
MRI abdomen w/o contrast (74181) $3,883.20 $3,883.20 15.2×
MRI any jt lower extrem w/contrast material (73722) $3,945.95 $3,945.95 4.7×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $6,736.70 $6,736.70 18.1×
MRI c-spine with contrast (72142) $4,713.95 $4,713.95 12.7×
MRI cervical spine w/o contrast (72141) $3,932.90 $3,932.90 15.4×
MRI chest w/o & w/contrast material (71552) $8,522.55 $8,522.55 22.9×
MRI chest w/o contrast (71550) $3,883.20 $3,883.20 15.2×
MRI chest with contrast (71551) $4,655.10 $4,655.10 5.6×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $3,989.15 $3,989.15 10.7×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $6,736.70 $6,736.70 18.1×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $3,614.95 $3,614.95 14.2×
MRI orbit face &/neck w/o contrast (70540) $3,864.90 $3,864.90 15.2×
MRI orbit/face/neck w&w/o cont (70543) $8,574.90 $8,574.90 23.0×
MRI pelvis w/contrast (72196) $4,655.10 $4,655.10 12.5×
MRI pelvis w/o & w/contrast material (72197) $8,602.30 $8,602.30 23.1×
MRI pelvis w/o contrast (72195) $3,883.20 $3,883.20 15.2×
MRI spinal canal cervical w/o & w/contr matrl (72156) $8,730.55 $8,730.55 23.4×
MRI spinal canal lumbar w/contrast material (72149) $4,713.95 $4,713.95 12.7×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $8,730.55 $8,730.55 23.4×
MRI spinal canal thoracic w/contrast matrl (72147) $4,713.95 $4,713.95 12.7×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $8,730.55 $8,730.55 23.4×
MRI temporomandibular joint (70336) $3,932.90 $3,932.90 15.4×
MRI thoracic spine w/o contrast (72146) $4,362 $4,362 17.1×
MRI up ext w/o contrast (73218) $3,614.95 $3,614.95 14.2×
MRI upper ext joint w/o contrast (73221) $3,614.95 $3,614.95 14.2×
MRI, joint upper extrem combo (73223) $6,736.70 $6,736.70 18.1×
Myocardial Spect Multiple Studies (78452) $2,642.90 $2,642.90 1.9×
Myocardial spect single study at rest or stress (78451) $2,560.40 $2,560.40 1.9×
Neck soft tissue (70360) $221.15 $221.15 2.4×
Nm gastric emptying study (78264) $2,713.45 $2,713.45 6.4×
Nonvascular shunt X-ray (75809) $413.50 $413.50 3.7×
Osseous survey limited (77074) $554.80 $554.80 5.0×
Pelvis 1 or 2 views (72170) $269.50 $269.50 2.4×
Pulmonary Perfusion Imaging Particulate (78580) $2,251.60 $2,251.60 5.3×
Pulmonary Ventilation & Perfusion Imaging (78582) $3,579.65 $3,579.65 6.2×
Radex Ankle Compl Minimum 3 Views (73610) $277.35 $277.35 3.0×
Radex Calcaneus Minimum 2 Views (73650) $268.20 $268.20 2.9×
Radex Elbw Compl Minimum 3 Views (73080) $304.90 $304.90 3.3×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $226.30 $226.30 2.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $268.20 $268.20 2.4×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) $272.40 $272.40 2.4×
Radex fingr minimum 2 views (73140) $221.15 $221.15 2.4×
Radex Foot Compl Minimum 3 Views (73630) $337.55 $337.55 3.6×
Radex Hand Minimum 3 Views (73130) $277.35 $277.35 3.0×
Radex Hip Unilateral With Pelvis 1 View (73501) $247.30 $247.30 2.7×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $378.10 $378.10 3.4×
Radex Hips Bilateral With Pelvis 2 Views (73521) $490.60 $490.60 4.4×
Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) $626.70 $626.70 5.6×
Radex Humerus Minimum 2 Views (73060) $304.90 $304.90 3.3×
Radex Kne 1/2 Views (73560) $269.50 $269.50 2.9×
Radex Kne Compl 4/More Views (73564) $331 $331 3.0×
Radex Mndbl Compl Minimum 4 Views (70110) $417.30 $417.30 3.7×
Radex Nasal Bones Complete Minimum 3 Views (70160) $269.50 $269.50 2.9×
Radex Pelvis Compl Minimum 3 Views (72190) $355.90 $355.90 3.2×
Radex Sho Compl Minimum 2 Views (73030) $304.90 $304.90 3.3×
Radex Sinuses Paransl < 3 Views (70210) $331 $331 3.6×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $476.20 $476.20 4.3×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $444.80 $444.80 4.8×
Radex Toe Minimum 2 Views (73660) $221.15 $221.15 2.4×
Radex upper extremity infant minimum 2 views (73092) $256.45 $256.45 2.3×
Radex Wrst Compl Minimum 3 Views (73110) $312.70 $312.70 3.4×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $269.50 $269.50 2.9×
Radiologic exam chest 2 views (71046) $331 $331 3.6×
Radiologic exam colon single contrast study (74270) $904.05 $904.05 4.8×
Radiologic Exam Esophagus Double Contrast Study (74221) $625.40 $625.40 3.3×
Radiologic exam upr gi trc double contrast study (74246) $870 $870 4.6×
Radiologic exam upr gi trc single contrast study (74240) $769.35 $769.35 4.1×
Radiologic examination femur 1 view (73551) $209.35 $209.35 2.3×
Radiologic examination tibia & fibula 2 views (73590) $268.20 $268.20 2.9×
Radiological examination surgical specimen (76098) $268.20 $268.20 0.5×
Ribs bilateral 3 views (71110) $413.50 $413.50 3.7×
Rp loclzj tum spect 1 area single day imaging (78803) $2,451.80 $2,451.80 4.2×
Sacroiliac Joints < 3 Views (72200) $269.50 $269.50 2.4×
Saline Infus Sonohysterography W/Color Doppler (76831) $809.85 $809.85 3.2×
Scapula (73010) $269.50 $269.50 2.4×
Screening Digital Breast Tomosynthesis Bi (77063) $261.65 $261.65 11.2×
Shoulder 1 view (73020) $246 $246 2.6×
Small bowel series (74250) $689.50 $689.50 3.7×
Spine thoracic 3 views (72072) $392.45 $392.45 3.5×
Thoracolumbar 2 views (72080) $355.90 $355.90 3.8×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,957.30 $1,957.30 4.6×
Ultrasound breast complete (76641) $554.80 $554.80 5.0×
Ultrasound Exam Aaa Screen (76706) $761.45 $761.45 6.8×
Ultrasound, abdomen limited (76705) $747.15 $747.15 6.7×
Umbilical-artery Doppler (OB) (76820) $397.70 $397.70 3.6×
Urethrocystogram voiding (74455) $839.95 $839.95 3.3×
Urethrocystography retrograde rs&i (74450) $927.65 $927.65 3.6×
Us breast unilateral limited (76642) $485.40 $485.40 5.2×
Us chest (76604) $689.50 $689.50 6.2×
Us compl joint r-t w/image documentation (76881) $696.05 $696.05 6.2×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $149.15 $149.15 1.3×
Us ob detailed single fetus (76811) $1,183.80 $1,183.80 4.6×
Us ob limited (76815) $429.18 $429.18 3.8×
Us ob transvaginal (76817) $470.35 $470.35 4.2×
Us pelvic non ob complete (76856) $809.85 $809.85 7.3×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $362.42 $362.42 3.2×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $1,108.15 $1,108.15 9.9×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $467.75 $467.75 4.2×
Us retroperitoneal complete (76770) $1,040.15 $1,040.15 9.3×
Us retroperitoneal limited (76775) $291 $291 2.6×
Us scrotum and contents (76870) $821.60 $821.60 7.4×
Us soft tissue head/neck (76536) $822.90 $822.90 7.4×
Us spinal canal and contents (76800) $751 $751 6.7×
Us, eye b-scan (76512) $265.85 $265.85 2.4×
Vertebral fracture assessment via dxa (77086) $133.45 $133.45 1.4×
Wrist 2 views (73100) $256.45 $256.45 2.8×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $392.45 $392.45 3.5×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $444.80 $444.80 4.8×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $1,180.10 $1,180.10 6.3×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $269.50 $269.50 2.9×
X-Ray Exam Hip Uni 2-3 Views (73502) $304.90 $304.90 3.3×
X-Ray Exam Hips Bi 3-4 Views (73522) $371.60 $371.60 3.3×
X-ray exam of femur 2/> (73552) $304.90 $304.90 3.3×
X-ray eye for foreign body (70030) $221.15 $221.15 2.4×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $331 $331 3.6×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $269.50 $269.50 2.9×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $298.25 $298.25 3.2×
X-ray leg, infant (73592) $256.45 $256.45 2.8×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $355.90 $355.90 3.2×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $625.40 $625.40 5.6×
X-ray nose-rectum child f.b. (76010) $269.50 $269.50 2.9×
X-ray optic foramen (70190) $331 $331 3.6×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $413.50 $413.50 3.7×
X-ray retrograde pyelogram (74420) $1,231.15 $1,231.15 3.3×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $304.90 $304.90 3.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $355.90 $355.90 3.2×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $476.20 $476.20 4.3×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $331 $331 3.0×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $304.90 $304.90 3.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $413.50 $413.50 4.5×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $476.20 $476.20 4.3×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $331 $331 3.0×
X-Ray Spine One View - Xr Spine (72020) $221.15 $221.15 2.4×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $376.80 $376.80 4.1×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $346.75 $346.75 3.7×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $346.75 $346.75 3.1×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $485.40 $485.40 4.3×
Xr bone length studies (77073) $386 $386 3.5×
Xr c-spine 4 or 5 views (72050) $476.20 $476.20 4.3×
Xr c-spine 6 or more views (72052) $595.30 $595.30 5.3×
Xr chest 4+ views (71048) $413.50 $413.50 3.7×
Xr urogram antegrade (74425) $689.50 $689.50 1.9×