Western Maine Health Menu
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Diagnostic Services - Insertion Of Needle Into Scalp Vein, Patient Younger Than 3 Years (920000001) | $24.15 |
N/A
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Diagnostic Services - Fetal Non-Stress Test (920000003) | $452.55 |
N/A
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Diagnostic Services - Complete Ultrasound Scan Of Abdominal, Pelvic, Or Scrotal Blood Vessels (893975) | $617.40 |
N/A
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Diagnostic Services - Ambulatory Blood Pressure Monitoring For 24 Hours Or Longer, Includes Recording Only (893786) | $249.90 |
N/A
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Diagnostic Services - Ambulatory Blood Pressure Monitoring For 24 Hours Or Longer, Includes Recording Only (920000031) | $249.90 |
N/A
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Diagnostic Imaging - X-Rays For Limited And Focused Bone Survey (877074) | $1,278.90 |
N/A
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Diagnostic Imaging - X-Rays For Complete Skeletal Bone Survey (877075) | $1,278.90 |
N/A
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Diagnostic Imaging - X-Rays For Complete Infant Bone Survey (877076) | $263.55 |
N/A
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Diagnostic Imaging - X-Rays For Bone Length Studies (877073) | $768.60 |
N/A
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Diagnostic Imaging - X-Rays For Bone Age Studies (877072) | $222.60 |
N/A
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Diagnostic Imaging - X-Ray Of Wrist, 3 Or More Views (873110) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Wrist, 2 Views (873100) | $232.05 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Spine, 6 Or More Views (872052) | $792.75 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Spine, 4 Or 5 Views (872050) | $396.90 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Spine, 2 Or 3 Views (872040) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Leg, 2 Or More Views (873552) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Leg, 1 View (873551) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Digestive Tract Without X-Ray Of Urinary System (874240) | $1,009.05 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Digestive Tract With X-Ray Of Urinary System (874241) | $1,260.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Digestive Tract With X-Ray Of Small Intestines (874245) | $1,650.60 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Arm, 2 Or More Views (873060) | $318.15 |
N/A
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Diagnostic Imaging - X-Ray Of Toe(S), 2 Or More Views (873660) | $260.40 |
N/A
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Diagnostic Imaging - X-Ray Of Surgical Specimen (876098) | $117.60 |
N/A
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Diagnostic Imaging - X-Ray Of Spine, 1 View (872020) | $187.95 |
N/A
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Diagnostic Imaging - X-Ray Of Spine For Scoliosis Evaluation, 2 Or 3 Views (872082) | $777.00 |
N/A
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Diagnostic Imaging - X-Ray Of Spine For Scoliosis Evaluation, 1 View (872081) | $777.00 |
N/A
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Diagnostic Imaging - X-Ray Of Soft Tissue Of Neck (870360) | $179.55 |
N/A
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Diagnostic Imaging - X-Ray Of Small Intestine (874250) | $632.10 |
N/A
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Diagnostic Imaging - X-Ray Of Skull, 4 Or More Views (870260) | $380.10 |
N/A
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Diagnostic Imaging - X-Ray Of Skull, 1 To 3 Views (870250) | $237.30 |
N/A
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Diagnostic Imaging - X-Ray Of Shoulder, 2 Or More Views (873030) | $332.85 |
N/A
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Diagnostic Imaging - X-Ray Of Shoulder, 1 View (873020) | $193.20 |
N/A
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Diagnostic Imaging - X-Ray Of Shoulder Blade (873010) | $278.25 |
N/A
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Diagnostic Imaging - X-Ray Of Sacrum And Tailbone, 2 Or More Views (872220) | $584.85 |
N/A
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Diagnostic Imaging - X-Ray Of Sacroiliac Joints, Fewer Than 3 Views (872200) | $389.55 |
N/A
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Diagnostic Imaging - X-Ray Of Sacroiliac Joints, 3 Or More Views (872202) | $504.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On One Side Of Body, 2 Views (871100) | $313.95 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On One Side Of Body With X-Ray Of Chest, 3 Or More Views (871101) | $572.25 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On Both Sides Of Body, 3 Views (871110) | $463.05 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On Both Sides Of Body With X-Ray Of Chest, 4 Or More Views (871111) | $719.25 |
N/A
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Diagnostic Imaging - X-Ray Of Pelvis, 3 Or More Views (872190) | $508.20 |
N/A
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Diagnostic Imaging - X-Ray Of Pelvis, 1 Or 2 Views (872170) | $298.20 |
N/A
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Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 4 Or More Views (873503) | $441.00 |
N/A
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Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 2 To 3 Views (873502) | $441.00 |
N/A
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Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 1 View (873501) | $220.50 |
N/A
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Diagnostic Imaging - X-Ray Of Nose Bones, 3 Or More Views (870160) | $325.50 |
N/A
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Diagnostic Imaging - X-Ray Of Nasal Sinuses, 3 Or More Views (870220) | $428.40 |
N/A
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Diagnostic Imaging - X-Ray Of Nasal Sinuses, 1 To 2 Views (870210) | $138.60 |
N/A
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Diagnostic Imaging - X-Ray Of Middle Spine, 4 Or More Views (872074) | $491.40 |
N/A
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Diagnostic Imaging - X-Ray Of Middle Spine, 2 Views (872070) | $338.10 |
N/A
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Diagnostic Imaging - X-Ray Of Middle And Lower Spine, 2 Or More Views (872080) | $338.10 |
N/A
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Diagnostic Imaging - X-Ray Of Mastoid (Bone Behind Ear), 3 Or More Views Per Side (870130) | $563.85 |
N/A
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Diagnostic Imaging - X-Ray Of Mastoid (Bone Behind Ear), 1 To 2 Views Per Side (870120) | $431.55 |
N/A
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Diagnostic Imaging - X-Ray Of Mandible (Jaw Bone), 4 Or More Views (870110) | $632.10 |
N/A
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Diagnostic Imaging - X-Ray Of Mandible (Jaw Bone), 1 To 3 Views (870100) | $431.55 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), With 2 Or 3 Bending Views Only (872120) | $508.20 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), 4 Or More Views (872110) | $750.75 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), 2 Or 3 Views (872100) | $508.20 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral) With Bending Views, 6 Or More Views (872114) | $1,198.05 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Leg, 2 Views (873590) | $379.05 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 4 Or More Views (873564) | $446.25 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 3 Views (873562) | $379.05 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 1 Or 2 Views (873560) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Jaw Joint, Both Sides (870330) | $572.25 |
N/A
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Diagnostic Imaging - X-Ray Of Heel, 2 Or More Views (873650) | $298.20 |
N/A
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Diagnostic Imaging - X-Ray Of Hand, 3 Or More Views (873130) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Hand, 2 Views (873120) | $232.05 |
N/A
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Diagnostic Imaging - X-Ray Of Forearm, 2 Views (873090) | $301.35 |
N/A
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Diagnostic Imaging - X-Ray Of Foot, 3 Or More Views (873630) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Foot, 2 Views (873620) | $232.05 |
N/A
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Diagnostic Imaging - X-Ray Of Finger(S), 2 Or More Views (873140) | $260.40 |
N/A
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Diagnostic Imaging - X-Ray Of Face Bones, 3 Or More Views (870150) | $572.25 |
N/A
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Diagnostic Imaging - X-Ray Of Face Bones, 1 To 2 Views (870140) | $431.55 |
N/A
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Diagnostic Imaging - X-Ray Of Eye Socket Opening In Skull (870190) | $444.15 |
N/A
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Diagnostic Imaging - X-Ray Of Eye Socket Bones, 4 Or More Views (870200) | $540.75 |
N/A
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Diagnostic Imaging - X-Ray Of Eye For Foreign Body (870030) | $111.30 |
N/A
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Diagnostic Imaging - X-Ray Of Esophagus (874220) | $380.10 |
N/A
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Diagnostic Imaging - X-Ray Of Elbow, 3 Or More Views (873080) | $301.35 |
N/A
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Diagnostic Imaging - X-Ray Of Elbow, 2 Views (873070) | $187.95 |
N/A
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Diagnostic Imaging - X-Ray Of Collarbone (873000) | $292.95 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 4 Or More Views (871048) | $653.10 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 3 Views (871047) | $491.40 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 2 Views (871046) | $379.05 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 1 View (871045) | $285.60 |
N/A
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Diagnostic Imaging - X-Ray Of Breast Bone, 2 Or More Views (871120) | $572.25 |
N/A
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Diagnostic Imaging - X-Ray Of Breast And Collarbone Joint, 2 Or More Views (871130) | $664.65 |
N/A
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Diagnostic Imaging - X-Ray Of Both Shoulder To Collarbone Joints (873050) | $563.85 |
N/A
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Diagnostic Imaging - X-Ray Of Both Knees, Standing (873565) | $303.45 |
N/A
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Diagnostic Imaging - X-Ray Of Both Hips With Pelvis, 2 Views (873521) | $1,136.10 |
N/A
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Diagnostic Imaging - X-Ray Of Bile Or Pancreatic Ducts With Contrast Injection During Surgery (874300) | $761.25 |
N/A
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Diagnostic Imaging - X-Ray Of Ankle, 3 Or More Views (873610) | $298.20 |
N/A
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Diagnostic Imaging - X-Ray Of Ankle, 2 Views (873600) | $232.05 |
N/A
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Diagnostic Imaging - X-Ray Of Abdomen, 3 Or More Views (874021) | $483.00 |
N/A
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Diagnostic Imaging - X-Ray Of Abdomen, 2 Views (874019) | $366.45 |
N/A
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Diagnostic Imaging - X-Ray Of Abdomen, 1 View (874018) | $277.20 |
N/A
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Diagnostic Imaging - Vaginal Ultrasound Of Fetus (876817) | $452.55 |
N/A
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Diagnostic Imaging - Ultrasound Of Uterus (876831) | $725.55 |
N/A
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Diagnostic Imaging - Ultrasound Of Transplanted Kidney (876776) | $1,023.75 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Or First Fetus At Less Than 14 Weeks (876801) | $684.60 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Or First Fetus At 14 Weeks Or Greater (876805) | $1,109.85 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Breast, Limited Study (876642) | $243.60 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (876641) | $485.10 |
N/A
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Diagnostic Imaging - Ultrasound Of Scrotum (876870) | $634.20 |
N/A
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Diagnostic Imaging - Ultrasound Of Pelvis Through Vagina (876830) | $597.45 |
N/A
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Diagnostic Imaging - Ultrasound Of Infant Hips With Manipulation (876885) | $559.65 |
N/A
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Diagnostic Imaging - Ultrasound Of Head And Neck (876536) | $557.55 |
N/A
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Diagnostic Imaging - Ultrasound Of Female Pelvic Organs, Limited Study (876857) | $479.85 |
N/A
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Diagnostic Imaging - Ultrasound Of Female Pelvic Organs, Complete Study (876856) | $1,109.85 |
N/A
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Diagnostic Imaging - Ultrasound Of Chest (876604) | $485.10 |
N/A
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Diagnostic Imaging - Ultrasound Of Arm Or Leg, Limited Study (876882) | $247.80 |
N/A
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Diagnostic Imaging - Ultrasound Of Arm Or Leg, Complete Joint Study (876881) | $442.05 |
N/A
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Diagnostic Imaging - Ultrasound Of Additional Fetus At Less Than 14 Weeks (876802) | $515.55 |
N/A
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Diagnostic Imaging - Ultrasound Of Additional Fetus At 14 Weeks Or Greater (876810) | $1,841.70 |
N/A
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Diagnostic Imaging - Ultrasound Of Abdomen, Limited Study (876705) | $594.30 |
N/A
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Diagnostic Imaging - Ultrasound Of Abdomen, Complete Study (876700) | $1,083.60 |
N/A
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Diagnostic Imaging - Ultrasound Guidance For Needle Insertion (876942) | $599.55 |
N/A
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Diagnostic Imaging - Ultrasound Guidance For Blood Vessel Access As Additional Procedure (402000031) | $298.20 |
N/A
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Diagnostic Imaging - Ultrasound Guidance For Blood Vessel Access As Additional Procedure (876937) | $298.20 |
N/A
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Diagnostic Imaging - Ultrasound Behind Abdominal Cavity, Limited Study (876775) | $598.50 |
N/A
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Diagnostic Imaging - Ultrasound Behind Abdominal Cavity, Complete Study (876770) | $919.80 |
N/A
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Diagnostic Imaging - Single Plane X-Ray Of Single Body Section (876100) | $642.60 |
N/A
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Diagnostic Imaging - Screening Ultrasound Of Abdominal Aorta To Detect Bulging (876706) | $684.60 |
N/A
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Diagnostic Imaging - Screening Mammogram Of Both Breasts (877067) | $204.75 |
N/A
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Diagnostic Imaging - Removal Of Fluid From Abdominal Cavity With Imaging Guidance (849083) | $684.60 |
N/A
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Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, Without Contrast (872141) | $1,720.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, With Contrast (872142) | $1,923.60 |
N/A
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Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, With And Without Contrast (872156) | $1,477.35 |
N/A
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Diagnostic Imaging - Mri Scan Of Single Breast Without Contrast (8C8903) | $625.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Single Breast Without Contrast (877046) | $625.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Single Breast With And Without Contrast (8C8905) | $625.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Pelvis, Without Contrast (872195) | $2,032.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Pelvis, With And Without Contrast (872197) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, Without Contrast (872146) | $1,878.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, With Contrast (872147) | $2,173.50 |
N/A
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Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, With And Without Contrast (872157) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, Without Contrast (872148) | $1,878.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, With Contrast (872149) | $1,715.70 |
N/A
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Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, With And Without Contrast (872158) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg, Without Contrast (873718) | $1,720.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg, With And Without Contrast (873720) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg Joint, Without Contrast (873721) | $1,720.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg Joint, With Contrast (873722) | $1,874.25 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg Joint, With And Without Contrast (873723) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Jaw Joint (870336) | $2,032.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, Without Contrast (870540) | $2,032.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, With And Without Contrast (870543) | $2,497.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Chest, Without Contrast (871550) | $2,032.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Chest, With And Without Contrast (871552) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Brain, Without Contrast (870551) | $2,032.80 |
N/A
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Diagnostic Imaging - Mri Scan Of Brain, With Contrast (870552) | $2,497.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Brain, With And Without Contrast (870553) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Both Breasts Without Contrast (8C8906) | $750.75 |
N/A
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Diagnostic Imaging - Mri Scan Of Both Breasts Without Contrast (877047) | $750.75 |
N/A
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Diagnostic Imaging - Mri Scan Of Both Breasts With And Without Contrast (8C8908) | $750.75 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm, Without Contrast (873218) | $1,720.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm, With And Without Contrast (873220) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm Joint, Without Contrast (873221) | $1,720.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm Joint, With Contrast (873222) | $1,967.70 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm Joint, With And Without Contrast (873223) | $2,655.45 |
N/A
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Diagnostic Imaging - Mri Scan Of Abdomen, Without Contrast (874181) | $2,596.65 |
N/A
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Diagnostic Imaging - Mri Scan Of Abdomen, With Contrast (874182) | $2,497.95 |
N/A
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Diagnostic Imaging - Mri Scan Of Abdomen, With And Without Contrast (874183) | $2,497.95 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Neck, Without Contrast (870547) | $1,720.95 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Neck, With Contrast (870548) | $1,720.95 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Neck, With And Without Contrast (870549) | $2,266.95 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Head, Without Contrast (870544) | $1,720.95 |
N/A
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Diagnostic Imaging - Motion Recording Of Swallowing Function (874230) | $428.40 |
N/A
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Diagnostic Imaging - Mammogram Of Single Breast (877065) | $169.05 |
N/A
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Diagnostic Imaging - Mammogram Of Both Breasts (877066) | $313.95 |
N/A
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Diagnostic Imaging - Low Dose Ct Scan For Lung Cancer Screening (352000001) | $601.65 |
N/A
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Diagnostic Imaging - Limited Ultrasound Of One Or More Fetuses (876815) | $452.55 |
N/A
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Diagnostic Imaging - Guidance For Procedure, Up To 1 Hour (8376000) | $570.15 |
N/A
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Diagnostic Imaging - Guidance For Procedure, Up To 1 Hour (876000) | $570.15 |
N/A
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Diagnostic Imaging - Guidance For Placement Of Long Intestinal Tube In Small Intestine (874340) | $2,953.65 |
N/A
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Diagnostic Imaging - Guidance For Placement Of Drainage Device (875989) | $323.40 |
N/A
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Diagnostic Imaging - Guidance For Placement Of Drainage Device (402000061) | $200.00 |
N/A
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Diagnostic Imaging - Follow-Up Ultrasound Of Fetus (876816) | $684.60 |
N/A
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Diagnostic Imaging - Fluoroscopic Guidance For Needle Insertion (877002) | $736.05 |
N/A
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Diagnostic Imaging - Fluoroscopic Guidance For Central Venous Access Device Procedure (877001) | $382.20 |
N/A
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Diagnostic Imaging - Exam For Fetal Well-Being Without Non-Stress Testing (876819) | $1,331.40 |
N/A
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Diagnostic Imaging - Exam For Fetal Well-Being With Non-Stress Testing (876818) | $684.60 |
N/A
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Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study And Spinal Bone Fracture Assessment (877085) | $754.95 |
N/A
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Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (877080) | $754.95 |
N/A
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Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (877081) | $300.30 |
N/A
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Diagnostic Imaging - Diagnostic Scan Of Heart Motion And Blood Ejection, Single Study (878472) | $1,820.70 |
N/A
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Diagnostic Imaging - Detailed Ultrasound Of Single Or First Fetus (876811) | $1,047.90 |
N/A
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Diagnostic Imaging - Ct Scan Of Upper Spine, Without Contrast (872125) | $1,162.35 |
N/A
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Diagnostic Imaging - Ct Scan Of Upper Spine, With Contrast (872126) | $1,519.35 |
N/A
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Diagnostic Imaging - Ct Scan Of Pelvis, Without Contrast (872192) | $1,162.35 |
N/A
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Diagnostic Imaging - Ct Scan Of Pelvis, With Contrast (872193) | $1,367.10 |
N/A
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Diagnostic Imaging - Ct Scan Of Pelvis, With And Without Contrast (872194) | $1,541.40 |
N/A
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Diagnostic Imaging - Ct Scan Of Neck, Without Contrast (870490) | $1,441.65 |
N/A
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Diagnostic Imaging - Ct Scan Of Neck, With Contrast (870491) | $1,698.90 |
N/A
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Diagnostic Imaging - Ct Scan Of Neck, With And Without Contrast (870492) | $2,864.40 |
N/A
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Diagnostic Imaging - Ct Scan Of Middle Spine, Without Contrast (872128) | $1,600.20 |
N/A
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Diagnostic Imaging - Ct Scan Of Middle Spine, With Contrast (872129) | $1,621.20 |
N/A
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Diagnostic Imaging - Ct Scan Of Lower Spine, Without Contrast (872131) | $1,600.20 |
N/A
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Diagnostic Imaging - Ct Scan Of Lower Spine, With Contrast (872132) | $1,621.20 |
N/A
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Diagnostic Imaging - Ct Scan Of Leg, Without Contrast (873700) | $1,600.20 |
N/A
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Diagnostic Imaging - Ct Scan Of Leg, With Contrast (873701) | $1,883.70 |
N/A
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