Facility Name Acadia Hospital Phone: (207) 973-6100 Acadia Medical Arts Phone: (207) 990-0928 Affiliated Healthcare Systems Phone: (800) 639-3309 Aroostook Medical Center Phone: (207) 768-4000 Aroostook MRI LLC Phone: (207) 764-6121 Notes: MRI Services for Aroostook Medical Center Blue Hill Memorial Hospital Phone: (207) 374-3400 Bridgton Hospital Phone: (207) 647-6000 Calais Regional Hospital Phone: (207) 454-7521 Cary Medical Center Phone: (207) 498-3111 Central Maine Endoscopy Center Phone: (207) 680-2070 Central Maine Medical Center Phone: (207) 795-0111 Notes: Includes Central Maine Vascular Associates Charles A Dean Memorial Hospital Phone: (207) 695-5200 Dorothea Dix Psychiatric Center Phone: (207) 941-4000 Down East Community Hospital Phone: (207) 255-3356 Eastern Maine Medical Center Phone: (207) 973-7000 Franklin Memorial Hospital Phone: (207) 778-6031 Generation Day Surgery Center Phone: (207) 874-2445 Henrietta D Goodall Hospital Phone: (207) 324-4310 Houlton Regional Hospital Phone: (207) 532-2900 Notes: includes Houlton Radiology Inland Hospital Phone: (207) 861-3000 Notes: includes CV Diagnostics Insight Premier Health (Central Maine Imaging) Phone: (207) 795-2030 Insight Premier Health (Marshwood Imaging Center) Phone: (207) 883-3803 Insight Premier Health (Mobile Imaging Consortium) Phone: (207) 883-3803 Insight Premier Health (Open MRI Of Bangor) Phone: (207) 990-3900 Insight Premier Health (Open MRI Of Brunswick) Phone: (207) 721-1110 Intermed Imaging Services Phone: (207) 828-0361 Magnetic Resonance Imaging Phone: (207) 945-4680 Maine Center For Endoscopy Phone: (207) 857-9311 Maine Coast Memorial Hospital Phone: (207) 664-5311 Maine Coast Mobile Med LLC Phone: (207) 664-0533 Maine General Medical Center Phone: (207) 626-1000 Maine Medical Center Phone: (207) 662-0111 Maine Mobile MRI Associates Phone: (207) 746-6674 Maine Molecular Imaging Phone: (207) 883-1285 Martin's Point Health Care Phone: (207) 774-5801 Mayo Regional Hospital Phone: (207) 564-8401 Medical Laser Services Phone: (207) 761-0177 Mercy Hospital Phone: (207) 879-3000 Mid Coast Hospital Phone: (207) 729-0181 Miles Memorial Hospital Phone: (207) 563-1234 Millinocket Regional Hospital Phone: (207) 723-5161 Mobile Medical Imaging Services Phone: (207) 774-0720 Mount Desert Island Hospital Phone: (207) 288-5081 NEHE-MRI LLC Phone: (800) 646-6121 New England Health Imaging New England Molecular Imaging Phone: (207) 795-0111 New England Rehab Hospital Phone: (207) 775-4000 Northern Maine Ambulatory Endoscopy Phone: (207) 764-0679 Northern Maine Medical Center Phone: (207) 834-3155 Northern Maine Oral Facial Phone: (207) 764-6337 Orthopaedic Associates Of Portland Phone: (207) 828-2100 Parkview Adventist Medical Center Phone: (207) 373-2000 Penbay Womens Imaging Phone: (207) 596-8500 Penobscot Bay Medical Center Phone: (207) 596-8000 Penobscot Valley Hospital Phone: (207) 794-3321 Portland Endoscopy Center Phone: (207) 773-7964 Primecare Imaging Phone: (207) 282-3349 Redington Fairview Hospital Phone: (207) 474-5121 Riverview Psychiatric Center Phone: (207) 624-3975 Rumford Hospital Phone: (207) 369-1000 Sebasticook Valley Hospital Phone: (207) 487-5141 Southern Maine Medical Center Phone: (207) 283-7000 Spring Harbor Hospital Phone: (207) 761-2200 St Andrews Hospital Phone: (207) 633-2121 St Joseph Hospital Phone: (207) 262-1000 St Marys Regional Medical Center Phone: (207) 777-8100 Stephens Memorial Hospital Phone: (207) 743-5933 Waldo County General Hospital Phone: (207) 338-2500 Western Avenue Day Surgery Center Phone: (800) 924-3591 York Hospital Phone: (207) 363-4321

Procedure Type Procedure with CPT4 code Imaging MRI - Back (cpt4:72148) MRI - Knee (cpt4:73721) MRI - Pelvis (cpt4:72195) Myocardial Perfusion Imaging (cpt4:78465) Ultrasound - Breast (cpt4:76645) Ultrasound - Pelvic (cpt4:76856) Preventive Health Bronchoscopy (cpt4:31622) Colonoscopy (cpt4:45378) Mammogram (Screening) (cpt4:76092,77057,G0202) Radiology CT - Abdomen (cpt4:74160) CT - Chest (cpt4:71260) CT - Head (without contrast material) (cpt4:70450) CT - Pelvis (cpt4:72193) X-Ray Ankle (cpt4:73610) X-Ray Chest (cpt4:71020) X-Ray Foot (cpt4:73630) X-Ray Knee (cpt4:73562) X-Ray Shoulder (cpt4:73030) X-Ray Spine (cpt4:72100) X-Ray Wrist (cpt4:73110) Surgical Arthroscopic Knee Surgery (Outpatient) (cpt4:29881) Biopsy - Breast (Auto Vacuum) (cpt4:19103) Carpal tunnel release (cpt4:64721) Endoscopy with Biopsy of Cervix (cpt4:57454) Gallbladder Removal (cpt4:47562) Hernia Repair (Outpatient) (cpt4:49505) Kidney Stone Removal (cpt4:50590) Tonsillectomy with Adenoidectomy (Under age 12) (cpt4:42820) Total hip replacement (cpt4:27130)

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