Imaging prices at Monadnock Community Hospital

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

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

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ProcedureCash priceGross charge× Medicare
Abdomen 2 views (74019) $375.74 $626.24 3.4×
Acute gi blood loss imaging (78278) $1,070.99 $1,784.99 2.5×
Ankle 2 views (73600) $130.40 $217.33 1.4×
Arthrogram ankle (73615) $474.62 $791.04 1.3×
Arthrogram elbow (73085) $574.12 $956.87 1.5×
Arthrogram hip (73525) $520.36 $867.26 1.4×
Arthrogram knee (73580) $574.12 $956.87 1.5×
Arthrogram shoulder (73040) $574.12 $956.87 1.5×
Arthrogram wrist (73115) $574.12 $956.87 1.5×
Bone &/Joint Imaging Limited Area (78300) $830.59 $1,384.32 1.9×
Bone &/Joint Imaging Multiple Areas (78305) $878.18 $1,463.63 2.1×
Bone &/joint imaging whole body (78306) $1,195.83 $1,993.05 2.8×
Bone age studies (77072) $249.05 $415.09 2.2×
Bone Imaging 3 Phase (78315) $1,284.20 $2,140.34 3.0×
Bone survey complete (77075) $566.09 $943.48 5.1×
Bone survey infant (77076) $178.60 $297.67 1.6×
Bowel imaging (78290) $554.96 $924.94 1.3×
Brain Imaging Pet Metabolic Evaluation (78608) $2,401.55 $4,002.58 1.6×
Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) $886.21 $1,477.02 2.1×
Cervical spine 2 or 3 views (72040) $210.12 $350.20 2.3×
Chest 1 view (71045) $307.20 $512 3.3×
Chest xray 3 views (71047) $532.20 $887 5.7×
Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) $389.96 $649.93 2.1×
Clavicle complete (73000) $238.55 $397.58 2.6×
Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) $1,593.20 $2,655.34 14.3×
CT abdomen and pelvis without and with contrast (74178) $5,741.45 $9,569.08 15.4×
CT abdomen and pelvis without contrast (74176) $2,911.40 $4,852.33 11.4×
CT abdomen w contrast (74160) $1,674.39 $2,790.65 8.9×
CT abdomen w wo contrast (74170) $3,296.64 $5,494.40 17.6×
CT abdomen w/o contrast (74150) $1,318.81 $2,198.02 11.8×
CT angio lwr extr w/o&w/dye (73706) $1,979.06 $3,298.44 10.6×
CT angiography upper extremity lt (73206) $1,979.06 $3,298.44 10.6×
CT c-spine w/contrast (72126) $2,236.77 $3,727.95 6.0×
CT c-spine w/o contrast (72125) $2,019.62 $3,366.04 18.1×
CT cervical spine w&w/o contrast (72127) $2,958.59 $4,930.99 15.8×
CT chest w contrast (71260) $1,663.27 $2,772.11 8.9×
CT chest w/wo contrast (71270) $2,496.95 $4,161.58 13.3×
CT head/brain with contrast (70460) $1,594.05 $2,656.75 8.5×
CT head/brain without and with contrast (70470) $2,039.63 $3,399.38 10.9×
CT heart w/o contrast quant eval coronary calcium (75571) $150 $250 1.6×
CT iac w contrast (70481) $1,312.24 $2,187.07 7.0×
CT limited/localized follow up study (76380) $1,314.49 $2,190.81 14.1×
CT lower ext w/o (73700) $2,019.01 $3,365.01 18.1×
CT lower extremity w wo contrast (73702) $2,255.31 $3,758.85 12.0×
CT lower extremity w/contrast material (73701) $2,159.52 $3,599.20 11.5×
CT lumbar spine w & w/o contrast (72133) $3,432.60 $5,721 18.3×
CT lumbar spine w/contrast (72132) $3,056.86 $5,094.76 8.2×
CT lumbar spine w/o contrast (72131) $2,183.39 $3,638.99 19.6×
CT maxillofacial w contrast (70487) $1,768.33 $2,947.21 9.4×
CT maxillofacial w/wo contrast (70488) $2,278.79 $3,797.99 12.2×
CT maxillofacial wo contrast (70486) $1,679.11 $2,798.51 15.0×
CT orbit sella/post fossa/ear w/o & w/contr matr (70482) $2,278.79 $3,797.99 12.2×
CT orbits w/o contrast (70480) $1,224.26 $2,040.43 11.0×
CT pelvis w/o contrast (72192) $1,593.20 $2,655.34 14.3×
CT pelvis w/wo contrast (72194) $2,496.95 $4,161.58 13.3×
CT scan of arm combo (73202) $2,152.72 $3,587.87 11.5×
CT soft tissue neck w contrast (70491) $2,082.89 $3,471.48 11.1×
CT soft tissue neck w/o & w/contrast material (70492) $2,202.16 $3,670.27 11.8×
CT soft tissue neck w/o contrast (70490) $1,511.63 $2,519.38 13.5×
CT thoracic spine w/contrast (72129) $2,778.14 $4,630.23 14.8×
CT thoracic spine w/o contrast (72128) $1,981.93 $3,303.21 17.8×
CT thoracic spine w/wo contrast (72130) $3,124.84 $5,208.06 16.7×
CT thorax w/o contrast (71250) $1,593.20 $2,655.34 14.3×
CT upper ext wo (73200) $2,002.94 $3,338.23 17.9×
CT upper extremity with contrast (73201) $2,074.24 $3,457.06 5.6×
Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) $2,461.10 $4,101.84 13.1×
Cta Abdomen (74175) $1,982.15 $3,303.59 10.6×
CTA abdomen pelvis (74174) $3,846.43 $6,410.72 10.3×
CTA chest (71275) $1,982.15 $3,303.59 10.6×
Cta Head (70496) $2,963.96 $4,939.94 15.8×
Cta Neck (70498) $1,975.97 $3,293.29 10.6×
Cta Pelvis (72191) $1,982.15 $3,303.59 10.6×
Cystography minimum 3 views rs&i (74430) $697.10 $1,161.84 1.9×
Dxa bone density study 1/> sites axial skel (77080) $422.09 $703.49 3.8×
Esophageal motility (78258) $409.73 $682.89 1.0×
Esophagus (74220) $630.98 $1,051.63 3.4×
Facial bones min 3 views (70150) $354.73 $591.22 3.2×
Fetal Biophysical Profile W/O Non-Stress Testing (76819) $531.48 $885.80 4.8×
Fluoroscopy up to 1 hr (76000) $487.60 $812.67 1.9×
Foot 2 views (73620) $217.54 $362.56 2.3×
Forearm 2 views (73090) $278.10 $463.50 3.0×
Hand 2 views (73120) $229.90 $383.16 2.1×
Heart first pass single,planar (78481) $773.12 $1,288.53 1.3×
Heart Infarct Image (78466) $519.12 $865.20 1.2×
Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) $1,231.18 $2,051.96 2.1×
Hepatobiliary syst imaging including gallbladder (78226) $1,085.21 $1,808.68 2.5×
Hysterosalpingogram (74740) $550.02 $916.70 2.2×
Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) $242.26 $403.76 2.2×
Kidney imaging morphology (78700) $582.77 $971.29 1.4×
Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) $1,092.32 $1,820.52 1.9×
Kidney img morphology vascular flow 1 w/rx (78708) $1,452.30 $2,420.50 2.5×
Knee 3 views (73562) $393.05 $655.08 4.2×
Liver & spleen imaging static only (78215) $530.86 $884.77 1.2×
Liver & Spleen Imaging W/Vascular Flow (78216) $645.19 $1,075.32 1.5×
Lung ventilation imaging (78579) $660.64 $1,101.07 1.5×
Lymphoscintigraphy (78195) $817 $1,361.66 1.4×
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) $2,455.93 $4,093.22 2.9×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) $2,455.93 $4,093.22 6.6×
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) $4,162.85 $6,938.08 11.2×
Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) $94.55 $157.59 1.0×
MRA head w & w/o contrast (70546) $2,062.27 $3,437.11 5.5×
MRA head w/o contrast (70544) $1,750.18 $2,916.96 6.9×
MRA head with contrast (70545) $1,766.24 $2,943.74 4.7×
MRA neck w contrast (70548) $2,062.27 $3,437.11 5.5×
Mra Neck W/O &W/Contrast Material (70549) $2,157.44 $3,595.73 5.8×
MRA neck w/o contrast (70547) $1,943.61 $3,239.35 7.6×
MRI abdomen w contrast (74182) $1,989.96 $3,316.60 5.3×
MRI abdomen w/o & w/contrast material (74183) $3,885.37 $6,475.61 10.4×
MRI abdomen w/o contrast (74181) $1,766.86 $2,944.77 6.9×
MRI any jt lower extrem w/contrast material (73722) $2,431.21 $4,052.02 2.9×
MRI any jt lower extrem w/o & w/contrast matrl (73723) $4,041.72 $6,736.20 10.8×
MRI c-spine with contrast (72142) $2,950.33 $4,917.22 7.9×
MRI cervical spine w/o contrast (72141) $2,462.11 $4,103.52 9.7×
MRI chest w/o & w/contrast material (71552) $3,923.68 $6,539.47 10.5×
MRI chest w/o contrast (71550) $1,865.12 $3,108.54 7.3×
MRI chest with contrast (71551) $2,231.60 $3,719.33 2.7×
MRI lower extrem oth/thn jt w/contrast matrl (73719) $2,209.97 $3,683.28 5.9×
MRI lower extrem oth/thn jt w/o & w/contr matr (73720) $3,885.37 $6,475.61 10.4×
MRI lower extrem oth/thn jt w/o contr matrl (73718) $2,025.80 $3,376.34 8.0×
MRI orbit face &/neck w/o contrast (70540) $1,697.65 $2,829.41 6.7×
MRI orbit face neck w contrast (70542) $2,488.07 $4,146.78 6.7×
MRI orbit/face/neck w&w/o cont (70543) $4,416.23 $7,360.38 11.9×
MRI pelvis w/contrast (72196) $2,251.37 $3,752.29 6.0×
MRI pelvis w/o & w/contrast material (72197) $4,315.49 $7,192.49 11.6×
MRI pelvis w/o contrast (72195) $1,865.12 $3,108.54 7.3×
MRI spinal canal cervical w/o & w/contr matrl (72156) $4,265.44 $7,109.06 11.5×
MRI spinal canal lumbar w/contrast material (72149) $2,700.66 $4,501.10 7.2×
MRI spinal canal lumbar w/o & w/contr matrl (72158) $4,747.48 $7,912.46 12.7×
MRI spinal canal thoracic w/contrast matrl (72147) $2,491.78 $4,152.96 6.7×
MRI spinal canal thoracic w/o & w/contr matrl (72157) $3,553.50 $5,922.50 9.5×
MRI temporomandibular joint (70336) $2,216.77 $3,694.61 8.7×
MRI thoracic spine w/o contrast (72146) $2,014.06 $3,356.77 7.9×
MRI up ext w/o contrast (73218) $1,674.16 $2,790.27 6.6×
MRI upper ext joint w/o contrast (73221) $2,216.77 $3,694.61 8.7×
MRI, joint upper extrem combo (73223) $4,315.49 $7,192.49 11.6×
Myelogram Cervical (72240) $995.60 $1,659.33 1.2×
Myelogram Lumbar (72265) $1,205.10 $2,008.50 1.4×
Myelogram thoracic (72255) $995.60 $1,659.33 1.2×
Myelography 2 or more regions (72270) $1,636.46 $2,727.44 2.0×
Myocardial infarct spect (78469) $681.04 $1,135.06 1.2×
Myocardial Spect Multiple Studies (78452) $1,453.08 $2,421.79 1.1×
Myocardial spect single study at rest or stress (78451) $2,493.63 $4,156.05 1.8×
Neck soft tissue (70360) $208.88 $348.14 2.2×
Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) $483.28 $805.46 1.1×
Nm bone marrow wb (78104) $766.94 $1,278.23 1.8×
Nm gastric emptying study (78264) $1,570.96 $2,618.26 3.7×
Nm gastroesophageal reflux study (78262) $546.31 $910.52 1.3×
Nm kidney scan w/flow (78701) $633.45 $1,055.75 1.5×
Noncardiac Vascular Flow Imaging (78445) $530.86 $884.77 1.2×
Osseous survey limited (77074) $566.09 $943.48 5.1×
Parathyroid Planar Imaging (78070) $464.74 $774.56 1.1×
Parathyroid planar imaging w/wo subtraction (78071) $1,047.51 $1,745.85 2.5×
Pelvis 1 or 2 views (72170) $217.54 $362.56 1.9×
Pulmonary Perfusion Imaging Particulate (78580) $601.93 $1,003.22 1.4×
Pulmonary Ventilation & Perfusion Imaging (78582) $2,751.95 $4,586.59 4.7×
Radex abscess/fistula/sinus tract rs&i (76080) $169.95 $283.25 0.3×
Radex Ankle Compl Minimum 3 Views (73610) $228.66 $381.10 2.5×
Radex Calcaneus Minimum 2 Views (73650) $237.31 $395.52 2.6×
Radex Elbw Compl Minimum 3 Views (73080) $253.38 $422.30 2.7×
Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) $223.72 $372.86 2.4×
Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) $370.18 $616.97 3.3×
Radex fingr minimum 2 views (73140) $208.27 $347.11 2.2×
Radex Foot Compl Minimum 3 Views (73630) $314.56 $524.27 3.4×
Radex Hand Minimum 3 Views (73130) $292.93 $488.22 3.2×
Radex Hip Unilateral With Pelvis 1 View (73501) $374.51 $624.18 4.0×
Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) $432.60 $721 3.9×
Radex Hips Bilateral With Pelvis 2 Views (73521) $449.90 $749.84 4.0×
Radex Humerus Minimum 2 Views (73060) $288.61 $481.01 3.1×
Radex Kne 1/2 Views (73560) $241.64 $402.73 2.6×
Radex Kne Compl 4/More Views (73564) $417.77 $696.28 3.7×
Radex Mndbl Compl Minimum 4 Views (70110) $354.73 $591.22 3.2×
Radex Nasal Bones Complete Minimum 3 Views (70160) $309 $515 3.3×
Radex Pelvis Compl Minimum 3 Views (72190) $166.82 $278.04 1.5×
Radex Sho Compl Minimum 2 Views (73030) $448.67 $747.78 4.8×
Radex Sinuses Paransl < 3 Views (70210) $265.74 $442.90 2.9×
Radex Spine Lumbosacral Only Bending 2/3 Views (72120) $333.10 $555.17 3.0×
Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) $525.92 $876.53 5.7×
Radex Toe Minimum 2 Views (73660) $181.07 $301.79 1.9×
Radex upper extremity infant minimum 2 views (73092) $238.55 $397.58 2.1×
Radex Wrst Compl Minimum 3 Views (73110) $220.63 $367.71 2.4×
Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) $320.12 $533.54 3.4×
Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) $375.74 $626.24 3.4×
Radiologic exam chest 2 views (71046) $477 $795 5.1×
Radiologic exam colon single contrast study (74270) $589.57 $982.62 3.1×
Radiologic exam upr gi trc double contrast study (74246) $788.57 $1,314.28 4.2×
Radiologic exam upr gi trc single contrast study (74240) $585.86 $976.44 3.1×
Radiologic examination tibia & fibula 2 views (73590) $313.94 $523.24 3.4×
Radiological examination surgical specimen (76098) $418.80 $698 0.7×
Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) $543.84 $906.40 1.3×
Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) $645.19 $1,075.32 1.5×
Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) $978.29 $1,630.49 1.7×
Rp loclzj tum plnr whole body single day imaging (78802) $994.36 $1,657.27 1.7×
Rp loclzj tum spect 1 area single day imaging (78803) $1,315.10 $2,191.84 2.3×
Rp loclzj tum spect 2 area/sep acquisj img (78831) $2,271.15 $3,785.25 1.6×
Sacroiliac Joints < 3 Views (72200) $113.09 $188.49 1.0×
Saline Infus Sonohysterography W/Color Doppler (76831) $576.59 $960.99 2.3×
Scapula (73010) $278.10 $463.50 2.5×
Screening Digital Breast Tomosynthesis Bi (77063) $48 $80 2.1×
Sella turcica (70240) $211.97 $353.29 2.3×
Shoulder 1 view (73020) $177.98 $296.64 1.9×
Sialogram (70390) $634.07 $1,056.78 2.5×
Small bowel series (74250) $526.54 $877.56 2.8×
Testicular Imaging With Vascular Flow (78761) $519.12 $865.20 1.2×
Thoracolumbar 2 views (72080) $133.49 $222.48 1.4×
Thyroid carcinoma metastases img whole body (78018) $813.91 $1,356.51 1.4×
Thyroid imaging w/blood flow (78013) $920.20 $1,533.67 2.2×
Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) $1,219.93 $2,033.22 2.9×
Tmj unilateral (70328) $362.77 $604.61 3.9×
Ultrasound breast complete (76641) $280.57 $467.62 2.5×
Ultrasound Exam Aaa Screen (76706) $499.96 $833.27 4.5×
Ultrasound, abdomen limited (76705) $499.96 $833.27 4.5×
Umbilical-artery Doppler (OB) (76820) $234.84 $391.40 2.1×
Unlisted ultrasound procedure (76999) $554.35 $923.91 6.0×
Urethrocystogram voiding (74455) $503.05 $838.42 2.0×
Us breast unilateral limited (76642) $201.47 $335.78 2.2×
Us chest (76604) $302.20 $503.67 2.7×
Us compl joint r-t w/image documentation (76881) $307.76 $512.94 2.8×
Us encephalogram (76506) $554.35 $923.91 5.0×
Us infant hips w manipulation (76885) $540.75 $901.25 5.8×
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) $199.61 $332.69 1.8×
Us ob limited (76815) $364.62 $607.70 3.3×
Us ob transvaginal (76817) $642.72 $1,071.20 5.8×
Us pelvic non ob complete (76856) $639.63 $1,066.05 5.7×
Us pelvic nonobstetric image dcmtn limited/f/u (76857) $302.20 $503.67 2.7×
Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) $642.72 $1,071.20 5.8×
Us pg uter r-t img f-up tabdl appr pr fetus (76816) $420.86 $701.43 3.8×
Us retroperitoneal complete (76770) $710.70 $1,184.50 6.4×
Us retroperitoneal limited (76775) $499.96 $833.27 4.5×
Us scrotum and contents (76870) $302.20 $503.67 2.7×
Us soft tissue head/neck (76536) $486.36 $810.61 4.4×
Us spinal canal and contents (76800) $313.94 $523.24 2.8×
Us transrectal (76872) $621.09 $1,035.15 5.6×
Us transrectal prostate volume (76873) $179.22 $298.70 1.6×
Wrist 2 views (73100) $169.33 $282.22 1.8×
X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) $405.41 $675.68 3.6×
X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) $465.97 $776.62 5.0×
X-ray b.e. reductn intuss (74283) $766.32 $1,277.20 4.1×
X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) $929.47 $1,549.12 5.0×
X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) $193.43 $322.39 2.1×
X-Ray Exam Hip Uni 2-3 Views (73502) $412.21 $687.01 4.4×
X-ray exam of femur 2/> (73552) $285.52 $475.86 3.1×
X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) $228.66 $381.10 2.5×
X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) $187.25 $312.09 2.0×
X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) $357.20 $595.34 3.8×
X-ray leg, infant (73592) $292.93 $488.22 3.2×
X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) $216.92 $361.53 1.9×
X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) $446.81 $744.69 4.0×
X-ray nose-rectum child f.b. (76010) $245.96 $409.94 2.6×
X-ray optic foramen (70190) $264.50 $440.84 2.8×
X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) $330.01 $550.02 3.0×
X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) $307.15 $511.91 3.3×
X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) $342.99 $571.65 3.1×
X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) $459.79 $766.32 4.1×
X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) $294.17 $490.28 2.6×
X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) $210.12 $350.20 2.3×
X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) $380.07 $633.45 4.1×
X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) $217.54 $362.56 1.9×
X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) $196.52 $327.54 1.8×
X-Ray Spine One View - Xr Spine (72020) $250.91 $418.18 2.7×
X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) $262.65 $437.75 2.8×
X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) $278.10 $463.50 3.0×
X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) $330.63 $551.05 3.0×
Xr bone length studies (77073) $379.45 $632.42 3.4×
Xr c-spine 4 or 5 views (72050) $431.98 $719.97 3.9×
Xr c-spine 6 or more views (72052) $618 $1,030 5.5×
Xr chest 4+ views (71048) $587.40 $979 5.3×