Services Pricing

Services Pricing

The following is a list of some common services/procedures performed at Weeks Medical Center. It is important to note that these are price estimates. There may be additional related procedures, tests, treatments, or supplies provided and billed seperately. Patients may call 603-788-5354 to discuss more specific billing rates and procedures.

Emergency Department  CPT Code   Technical Component  Professional Component Total
ED Room Level I 99281 $253.00 $44.00 $297.00
ED Room Level II 99282 $466.00 $84.00 $550.00
ED Room Level III 99283 $833.00 $126.00 $959.00
ED Room Level IV 99284 $1,390.00 $239.00 $1,629.00
ED Room Level V 99285 $2,175.00 $353.00 $2,528.00
ED Room Critical Care 1st hour 99291 $2,832.00 $564.00 $3,396.00
ED Room Critical Care each Additional 30 min 99292 $326.00 $251.00 $577.00
  Primary Care Physician Office  CPT Code   Technical Component  Professional Component  Total
 Established
Clinic Visit – established 99211 $46.00 $46.00
Clinic Visit – established 99212 $84.00 $84.00
Clinic Visit – established 99213 $140.00 $140.00
Clinic Visit – established 99214 $206.00 $206.00
Clinic Visit – established 99215 $224.00 $224.00
 New Patient
Clinic Visit – new patient 99202 $143.00 $143.00
Clinic Visit – new patient 99203 $206.00 $206.00
Clinic Visit – new patient 99204 $314.00 $314.00
Clinic Visit – new patient 99205 $393.00 $393.00
Radiology  CPT Code   Technical Component  Professional Component  Total
 X-Ray
Chest Single Views 71010 $117.00 $19.00 $136.00
Chest 2 Views 71020 $301.00 $23.00 $324.00
Neck & Spine 4 Views 72050 $293.00 $34.00 $327.00
Lower Spine 72100 $217.00 $25.00 $242.00
Pelvis 1 or 2 Views 72170 $187.00 $20.00 $207.00
Femur 73552 $187.00 $20.00 $207.00
Knee 1 or 2 Views 73560 $193.00 $20.00 $213.00
Knee 3 Views 73562 $245.00 $21.00 $266.00
Foot 2 Views 73630 $208.00 $18.00 $226.00
Abdomen Complete 74020 $245.00 $29.00 $274.00
Esophagus 74220 $617.00 $48.00 $665.00
 CAT Scan
Scan Head without Contrast 70450 $721.00 $89.00 $810.00
Maxillofacial without Contrast 70486 $1,111.00 $118.00 $1,229.00
Scan Chest without Contrast 71250 $1,191.00 $118.00 $1,309.00
Chest with Contrast 71260 $1,568.00 $129.00 $1,697.00
Scan Pelvis without Contrast 72192 $856.00 $113.00 $969.00
Scan Abdomen without Contrast 74150 $837.00 $123.00 $960.00
Abdomen Angiogram 74175 $2,565.00 $195.00 $2,760.00
 MRI
Angiography Head without Contrast 70544 $3,061.00 $125.00 $3,186.00
Brain without Contrast 70551 $1,514.00 $153.00 $1,667.00
Brain With and without contrast 70553 $4,973.00 $239.00 $5,212.00
Cervical Spine without Contrast 72141 $1,492.00 $162.00 $1,654.00
Thoracic Spine without Contrast 72146 $1,492.00 $162.00 $1,654.00
Lumbar Spine without Contrast 72148 $3,078.00 $154.00 $3,232.00
Cervical Spine with and without Contrast 72156 $2,467.00 $260.00 $2,727.00
Thoracic Spine with and without Contrast 72157 $2,471.00 $261.00 $2,732.00
Lumbar Spine with and without Contrast 72158 $2,452.00 $239.00 $2,691.00
Pelvis with and without Contrast 72197 $3,617.00 $234.00 $3,851.00
Lower Extremity with and without Contrast 73720 $3,640.00 $223.00 $3,863.00
Lower Extremity without Contrast 73721 $1,646.00 $142.00 $1,788.00
 Ultrasound
Breast 76641 $601.00 $76.00 $677.00
Abdomen 76700 $813.00 $84.00 $897.00
Transvaginal 76830 $741.00 $73.00 $814.00
Carotid Duplex Scan Bilateral 93880 $1,523.00 $83.00 $1,606.00
 Other
Bone Density Study 77080 $343.00 $22.00 $365.00
Mammography Digital Screening G0202/77051 $916.00 $72.00 $988.00
 Laboratory  CPT Code   Technical Component  Professional Component  Total
Venous Specimen Collection Fee 36415 $22.00 $22.00
Basic Metabolic Panel 80048 $63.00 $63.00
Lipid Panel 80061 $112.00 $112.00
Liver Function Profile 80076 $68.00 $68.00
Urinalysis 81001 $45.00 $45.00
Hemoglobin A1C 83036 $86.00 $86.00
Prostate Specific antigen (PSA) Total or Screening G0103/84153 $121.00 $121.00
Thyroid Stimulating Hormone 84443 $144.00 $144.00
Beta HCG – Pregnancy blood count 84702 $125.00 $125.00
Compete Blood Count w WBC Count 85025 $63.00 $63.00
Complete Blood Count with Differential 85027 $59.00 $59.00
Prothrombin Time 85610 $50.00 $50.00
Culture Urine 87086 $66.00 $66.00
 Outpatient Procedure  CPT Code   Technical Component  Professional Component  Total
Echocardiogram 93306 $1,411.00 $256.00 $1,667.00
Colonoscopy Screening GO121 $1,720.00 $762.00 $2,482.00