Imaging prices at Manchester Memorial Hospital

Manchester, CT · 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) $385.81 $385.81 3.1×
Acute gastrointestinal blood loss imaging (78278) $1,248.45 $1,248.45 2.6×
Angiography extremity bilateral rs&i (75716) $10,649.18 $10,649.18 2.8×
Angiography extremity unilateral rs&i (75710) $10,649.18 $10,649.18 2.8×
Angiography pelvic slctv/supraslctv rs&i (75736) $18,373.53 $18,373.53 2.8×
Angiography pulmonary bilateral slctv rs&i (75743) $10,649.18 $10,649.18 2.8×
Angiography pulmonary unilateral slctv rs&i (75741) $10,649.18 $10,649.18 2.8×
Angiography visceral slctv/supraslctv rs&i (75726) $18,373.53 $18,373.53 2.8×
Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) $11,251.63 $11,251.63 3.0×
Ankle 2 views (73600) $310.57 $310.57 3.0×
Aortography abdl bi iliofem low extrem cath rs&i (75630) $10,649.18 $10,649.18 2.8×
Aortography abdominal serialography rs&i (75625) $10,649.18 $10,649.18 2.8×
Bone &/Joint Imaging Limited Area (78300) $1,582.96 $1,582.96 3.3×
Bone &/joint imaging whole body (78306) $1,582.96 $1,582.96 3.3×
Bone age studies (77072) $385.81 $385.81 3.1×
Bone Imaging 3 Phase (78315) $1,582.96 $1,582.96 3.3×
Bone Marrow Imaging Limited Area (78102) $1,404.79 $1,404.79 2.9×
Bone survey complete (77075) $485.30 $485.30 3.9×
Cervical spine 2 or 3 views (72040) $310.57 $310.57 3.0×
Chest 1 view (71045) $310.57 $310.57 3.0×
Chest 3 views (71047) $310.57 $310.57 3.0×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $644.66 $644.66 3.1×
Clavicle complete (73000) $310.57 $310.57 3.0×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,831.60 $1,831.60 14.6×
CT abdomen and pelvis without and with contrast (74178) $4,052.88 $4,052.88 9.7×
CT abdomen and pelvis without contrast (74176) $3,663.19 $3,663.19 12.8×
CT abdomen w contrast (74160) $2,257.14 $2,257.14 10.7×
CT abdomen w wo contrast (74170) $2,974.19 $2,974.19 14.1×
CT abdomen w/o contrast (74150) $1,831.60 $1,831.60 14.6×
CT angio hrt w/3d image (75574) $650.46 $650.46 1.6×
CT angiography upper extremity lt (73206) $2,026.44 $2,026.44 9.6×
CT c-spine w/o contrast (72125) $1,831.60 $1,831.60 14.6×
CT cervical spine w&w/o contrast (72127) $2,026.44 $2,026.44 9.6×
CT cervical spine with contrast (72126) $2,176.09 $2,176.09 5.2×
CT chest w/wo contrast (71270) $2,737.26 $2,737.26 13.0×
CT chest with contrast (71260) $2,179.20 $2,179.20 10.4×
CT colonography screening (74263) $1,610.09 $1,610.09 5.6×
CT colonography w/o cntrst (74261) $1,813.47 $1,813.47 14.5×
CT head/brain with contrast (70460) $1,938.86 $1,938.86 9.2×
CT head/brain without and with contrast (70470) $2,163.63 $2,163.63 10.3×
CT heart no contrast quant eval coronry calcium (75571) $180 $180 1.7×
CT iac w contrast (70481) $2,232.20 $2,232.20 10.6×
CT lower ext w/o (73700) $1,831.60 $1,831.60 14.6×
CT lower extremity w wo contrast (73702) $2,618.77 $2,618.77 12.5×
CT lower extremity with contrast (73701) $1,995.26 $1,995.26 9.5×
CT lumbar spine w & w/o contrast (72133) $2,737.26 $2,737.26 13.0×
CT lumbar spine w/o contrast (72131) $1,831.60 $1,831.60 14.6×
CT lumbar spine with contrast (72132) $1,741.42 $1,741.42 4.2×
CT maxillofacial w contrast (70487) $2,004.63 $2,004.63 9.5×
CT maxillofacial w/o contrast (70486) $1,831.60 $1,831.60 14.6×
CT maxillofacial w/wo contrast (70488) $2,497.25 $2,497.25 11.9×
CT neck soft tissue w contrast (70491) $1,948.50 $1,948.50 9.3×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,016.41 $2,016.41 9.6×
CT orbits w/o contrast (70480) $1,879.93 $1,879.93 15.0×
CT pelvis w & w/o contrast (72194) $2,696.72 $2,696.72 12.8×
CT pelvis w/o contrast (72192) $1,831.60 $1,831.60 14.6×
CT soft tissue neck w/o & w/contrast material (70492) $2,456.68 $2,456.68 11.7×
CT soft tissue neck w/o contrast (70490) $1,831.60 $1,831.60 14.6×
CT thoracic spine w/contrast (72129) $2,176.09 $2,176.09 10.3×
CT thoracic spine w/o contrast (72128) $1,831.60 $1,831.60 14.6×
CT thoracic spine w/wo contrast (72130) $1,875.12 $1,875.12 8.9×
CT thorax w/o contrast (71250) $1,831.60 $1,831.60 14.6×
CT upper extremity w/o & w/contrast material (73202) $2,584.12 $2,584.12 12.3×
CT upper extremity w/o contrast rt (73200) $1,831.60 $1,831.60 14.6×
CT upper extremity with contrast (73201) $1,989.03 $1,989.03 4.8×
Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) $2,338.21 $2,338.21 11.1×
Cta Abdomen (74175) $3,463.64 $3,463.64 16.5×
CTA abdomen pelvis (74174) $4,052.88 $4,052.88 9.7×
CTA chest (71275) $3,438.72 $3,438.72 16.4×
Cta Head (70496) $3,999.88 $3,999.88 19.0×
CTA lwr ext w&w/o contrast (73706) $2,026.44 $2,026.44 9.6×
Cta Neck (70498) $3,999.88 $3,999.88 19.0×
Cta Pelvis (72191) $3,299.73 $3,299.73 15.7×
Cystography minimum 3 views rs&i (74430) $1,317.06 $1,317.06 3.1×
Dxa bone density study 1/> sites axial skel (77080) $385.81 $385.81 3.1×
Dxa bone density study 1/>sites appendiclr skel (77081) $310.57 $310.57 3.0×
Echoencephalography real time imaging (76506) $385.81 $385.81 3.1×
Esophagus (74220) $644.66 $644.66 3.1×
Fetal biophysical profile non-stress testing (76818) $701.47 $701.47 5.6×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $701.47 $701.47 5.6×
Fluoroscopy up to 1 hr (76000) $834.79 $834.79 2.9×
Foot 2 views (73620) $310.57 $310.57 3.0×
Forearm 2 views (73090) $310.57 $310.57 3.0×
Gated Heart Planar Single (78472) $1,248.45 $1,248.45 2.6×
Hand 2 views (73120) $385.81 $385.81 3.1×
Hand 3 views (73130) $310.57 $310.57 3.0×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,620.69 $1,620.69 2.5×
Hepatobiliary syst imaging including gallbladder (78226) $1,311.13 $1,311.13 2.7×
Ht muscle image spect sing (78451) $4,245.85 $4,245.85 2.7×
Humerus Min 2 Views Left (73060) $310.57 $310.57 3.0×
Hysterosalpingogram (74740) $1,235.95 $1,235.95 4.3×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,620.70 $1,620.70 2.5×
Kidney img morphology vascular flow 1 w/rx (78708) $1,578.25 $1,578.25 2.4×
Knee 3 views (73562) $310.57 $310.57 3.0×
Lung perf&ventilat diferentl (78598) $1,620.69 $1,620.69 2.5×
Lung perfusion differential (78597) $1,248.45 $1,248.45 2.6×
Lung Ventilation Imaging (78579) $1,298.55 $1,298.55 2.7×
Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) $10,856.67 $10,856.67 2.9×
Lymphangiography extremity only bilateral rs&i (75803) $5,454.88 $5,454.88 2.9×
Lymphoscintigraphy (78195) $1,620.70 $1,620.70 2.5×
Meckels Diverticulum (78290) $1,248.45 $1,248.45 2.6×
Mr safety determination physician/other qhp (76016) $314.76 $314.76 3.0×
Mr safety implant pos&/immoblj supvj phys/qhp (76019) $212.34 $212.34 3.0×
Mr safety implant&/fb assmt clin staf 1st 15 min (76014) $87.55 $87.55 2.5×
Mr safety implt electronics prepj supvj phys/qhp (76018) $328.13 $328.13 2.9×
MRA head w & w/o contrast (70546) $3,086.73 $3,086.73 7.4×
MRA head w/o contrast (70544) $2,182.32 $2,182.32 7.6×
Mra Neck W/O &W/Contrast Material (70549) $3,117.59 $3,117.59 7.5×
MRA neck w/o contrast (70547) $2,182.32 $2,182.32 7.6×
MRI abdomen w contrast (74182) $2,469.39 $2,469.39 5.9×
MRI abdomen w/o & w/contrast material (74183) $4,413.02 $4,413.02 10.6×
MRI abdomen w/o contrast (74181) $2,264.02 $2,264.02 7.9×
MRI any jnt lwr ext with con lt (73722) $2,648.03 $2,648.03 2.8×
MRI any jt upper extremity w/contrast matrl (73222) $2,648.03 $2,648.03 2.8×
MRI breast w/o contrast bilateral (77047) $2,763.24 $2,763.24 9.7×
MRI breast w/o contrast unilat (77046) $2,469.39 $2,469.39 8.6×
MRI c-spine with contrast (72142) $2,494.08 $2,494.08 6.0×
MRI cervical spine w/o contrast (72141) $2,182.32 $2,182.32 7.6×
MRI chest w/o & w/contrast material (71552) $3,102.16 $3,102.16 7.4×
MRI chest w/o contrast (71550) $2,171.52 $2,171.52 7.6×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,182.32 $2,182.32 7.6×
MRI orbit face &/neck w/o contrast (70540) $2,171.52 $2,171.52 7.6×
MRI orbit/face/neck w&w/o cont (70543) $3,117.59 $3,117.59 7.5×
MRI orbit/face/neck w/contrast (70542) $2,307.84 $2,307.84 5.5×
MRI pelvis w/o & w/contrast material (72197) $3,273.48 $3,273.48 7.8×
MRI pelvis w/o contrast (72195) $2,182.32 $2,182.32 7.6×
MRI scan of arm joint before and after contrast (73223) $3,117.59 $3,117.59 7.5×
MRI scan of leg joint before and after contrast (73723) $3,273.48 $3,273.48 7.8×
MRI spinal canal cervical w/o & w/contr matrl (72156) $3,117.59 $3,117.59 7.5×
MRI spinal canal lumbar w/contrast material (72149) $2,494.08 $2,494.08 6.0×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $3,117.59 $3,117.59 7.5×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,117.59 $3,117.59 7.5×
MRI thoracic spine w/o contrast (72146) $2,182.32 $2,182.32 7.6×
MRI tmj (70336) $2,805.84 $2,805.84 9.8×
MRI upper ext joint w/o contrast (73221) $2,182.32 $2,182.32 7.6×
MRI upper extrem other than jt w/o & w/contras (73220) $3,117.59 $3,117.59 7.5×
MRI upper extremity oth than jt w/o contr matrl (73218) $2,182.32 $2,182.32 7.6×
Myocardial Spect Multiple Studies (78452) $4,327.93 $4,327.93 2.8×
Neck soft tissue (70360) $310.57 $310.57 3.0×
Nm gastric emptying study (78264) $1,248.45 $1,248.45 2.6×
Nuclear medicine study from skull base to mid-thigh (78812) $6,640.11 $6,640.11 3.9×
Nuclear Rx Oral Admin (79005) $961.50 $961.50 3.4×
Osseous survey infant (77076) $385.81 $385.81 3.1×
Osseous survey limited (77074) $385.81 $385.81 3.1×
Parathyrd planar w/wo subtrj (78071) $1,404.79 $1,404.79 2.9×
Parathyroid imaging (78070) $1,248.45 $1,248.45 2.6×
Pelvis 1 or 2 views (72170) $385.81 $385.81 3.1×
PET image w/CT, skull-thigh (78815) $15,235.60 $15,235.60 8.9×
PET imaging CT for attenuation limited area (78814) $6,640.11 $6,640.11 3.9×
PET imaging for CT attenuation whole body (78816) $7,222.84 $7,222.84 4.2×
PET imaging limited area chest head/neck (78811) $6,640.11 $6,640.11 4.3×
PET whole body (78813) $6,640.11 $6,640.11 3.9×
Pr MRI, lower extr, w/o contrast f/u by contrast (73720) $3,273.48 $3,273.48 7.8×
Pulmonary Perfusion Imaging Particulate (78580) $1,248.45 $1,248.45 2.6×
Pulmonary Ventilation & Perfusion Imaging (78582) $1,620.70 $1,620.70 2.5×
Radex abscess/fistula/sinus tract rs&i (76080) $1,915.77 $1,915.77 2.9×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $312.67 $312.67 3.0×
Radex hips bilateral with pelvis 2 views (73521) $385.81 $385.81 3.1×
Radex mastoids compl minimum 3 views pr side (70130) $385.81 $385.81 3.1×
Radiolog exam mandible compl minimum 4 views (70110) $385.81 $385.81 3.1×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $310.57 $310.57 3.0×
Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) $310.57 $310.57 3.0×
Radiologic exam colon single contrast study (74270) $644.66 $644.66 3.1×
Radiologic exam upr gi trc double contrast study (74246) $838.41 $838.41 4.0×
Radiologic exam upr gi trc single contrast study (74240) $838.41 $838.41 4.0×
Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) $310.57 $310.57 3.0×
Radiological examination surgical specimen (76098) $1,798.60 $1,798.60 2.7×
Ribs bilateral 3 views (71110) $385.81 $385.81 3.1×
Rp loclzj tum spect 1 area single day imaging (78803) $5,470.53 $5,470.53 8.4×
Scanogram (77073) $385.81 $385.81 3.1×
Scapula complete (73010) $382.09 $382.09 3.0×
Screening digital breast tomosynthesis (77063) $61.44 $61.44 2.6×
Small bowel series (74250) $644.66 $644.66 3.1×
Spine thoracic 3 views (72072) $385.81 $385.81 3.1×
Thyroid uptake measurement (78012) $1,298.55 $1,298.55 2.7×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,248.45 $1,248.45 2.6×
Tmj unilateral (70328) $310.57 $310.57 3.0×
Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) $1,582.96 $1,582.96 3.3×
Ultrasound elastography first target lesion (76982) $380.14 $380.14 3.0×
Ultrasound, abdomen limited (76705) $718.61 $718.61 5.7×
Unlisted Ultrasound Procedure (76999) $310.57 $310.57 3.0×
Upper Extremity Infant (73092) $385.81 $385.81 3.1×
Urethrocystography retrograde rs&i (74450) $834.79 $834.79 2.9×
Urethrocystography voiding (74455) $1,483.97 $1,483.97 5.2×
Us abdl aorta screen aaa (76706) $540.19 $540.19 4.3×
Us breast unilateral complete (76641) $385.81 $385.81 3.1×
Us breast unilateral limited (76642) $375.21 $375.21 3.6×
Us chest (76604) $584.55 $584.55 4.7×
Us compl joint r-t w/image documentation (76881) $428.67 $428.67 3.4×
Us elastography parenchyma (76981) $380.14 $380.14 3.0×
Us guided compression repair (76936) $1,069.09 $1,069.09 4.1×
Us ob transvaginal (76817) $385.81 $385.81 3.1×
Us pelvic non ob complete (76856) $467.64 $467.64 3.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $467.64 $467.64 3.7×
Us pregnancy ltd (76815) $385.81 $385.81 3.1×
Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) $385.81 $385.81 3.1×
Us retroperitoneal complete (76770) $718.61 $718.61 5.7×
Us retroperitoneal limited (76775) $545.59 $545.59 4.4×
Us scrotum and contents (76870) $389.70 $389.70 3.1×
Us soft tissue head/neck (76536) $438.03 $438.03 3.5×
Us spinal canal and contents (76800) $385.81 $385.81 3.1×
Us xtr non-vasc lmtd (76882) $385.81 $385.81 3.1×
Venogram extremity bilateral (75822) $5,318.75 $5,318.75 2.8×
Venography extremity unilateral rs&i (75820) $5,318.75 $5,318.75 2.8×
Venography renal unilateral selective rs&i (75831) $10,649.18 $10,649.18 2.8×
Venography venous sinus/jugular cath rs&i (75860) $10,649.18 $10,649.18 2.8×
Wrist 2 views (73100) $310.57 $310.57 3.0×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $385.81 $385.81 3.1×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $310.57 $310.57 3.0×
X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) $310.57 $310.57 3.0×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $828.12 $828.12 3.9×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $310.57 $310.57 3.0×
X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) $310.57 $310.57 3.0×
X-ray exam hip uni 1 view (73501) $310.04 $310.04 3.0×
X-Ray Exam Hip Uni 2-3 Views (73502) $310.57 $310.57 3.0×
X-ray exam hip uni 4/> views (73503) $382.09 $382.09 3.0×
X-Ray Exam Hips Bi 3-4 Views (73522) $385.81 $385.81 3.1×
X-ray exam of femur 1 (73551) $310.57 $310.57 3.0×
X-ray eye for foreign body (70030) $310.57 $310.57 3.0×
X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) $385.81 $385.81 3.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $310.57 $310.57 3.0×
X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) $310.57 $310.57 3.0×
X-Ray Heel - Xr Calcaneus 2 Views Right (73650) $310.57 $310.57 3.0×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $290.25 $290.25 2.8×
X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) $385.81 $385.81 3.1×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $310.57 $310.57 3.0×
X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) $310.57 $310.57 3.0×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $385.81 $385.81 3.1×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $428.67 $428.67 3.4×
X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) $392.80 $392.80 3.1×
X-Ray Nasal Bones - Xr Nasal Bones (70160) $310.57 $310.57 3.0×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $385.81 $385.81 3.1×
X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) $385.81 $385.81 3.1×
X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) $1,317.06 $1,317.06 3.1×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $310.57 $310.57 3.0×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $385.81 $385.81 3.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $385.81 $385.81 3.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $385.81 $385.81 3.1×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $310.57 $310.57 3.0×
X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) $310.57 $310.57 3.0×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $310.57 $310.57 3.0×
X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) $310.57 $310.57 3.0×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $385.81 $385.81 3.1×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $385.81 $385.81 3.1×
X-Ray Spine One View - Xr Spine (72020) $310.57 $310.57 3.0×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $282.18 $282.18 2.7×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $310.57 $310.57 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $385.81 $385.81 3.1×
X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) $380.13 $380.13 3.0×
X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) $310.57 $310.57 3.0×
X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) $310.57 $310.57 3.0×
Xr c-spine 6 or more views (72052) $385.81 $385.81 3.1×
Xr chest 4+ views (71048) $385.81 $385.81 3.1×
Xr finger(s) 2+ views (73140) $310.57 $310.57 3.0×
Xr shoulder 1 view (73020) $310.57 $310.57 3.0×
Xr spine cervical 4 or 5 views (72050) $385.81 $385.81 3.1×
Xr tibia/fibula 2 views (73590) $310.57 $310.57 3.0×
Xr tmj bilateral (70330) $310.57 $310.57 3.0×
Xray knee 1 or 2 views rt (73560) $310.57 $310.57 3.0×