Virtual visits now available. You may be able to schedule a virtual visit with your provider. For more information, call your doctor’s office.
Covenant Health is an innovative, Catholic regional delivery network and a leader in values based, not-for-profit health and elder care. We sponsor hospitals, nursing homes, assisted living residences and other health and elder care organizations throughout New England.

Request A Price Estimate

Estimates are available for hospital procedures only.  Once we have received your request through the form below, we will contact you at a time that is most convenient for you to discuss the estimate generated specifically for you.

Understanding Your Estimate 

The information provided will be an estimate of the charges for services ordered and is not a guarantee of final billed charges. Additional charges will apply should the order change or if additional studies are required. Professional fees, such as surgeon, radiologist and CRNA are not included in this estimate. In addition, these charges may NOT include ALL charges for supplies and other supporting procedures. The estimated patient portion is due at the time of service unless previous arrangements have been made.

Example CPT Codes

CT Abd/Pelvis w/o contrast     CPT: 74176
CT Head w/o contrast               CPT: 70450
Chest X-ray PA/Lat                     CPT: 71020
Digital Mammo Screening        CPT: 77057
CAD for Mammo                     CPT: 77052 
MRI - Brain w/o contrast           
CPT: 70551
MRI - Extremity w/o contrast   
   Upper Extremity                      CPT: 73218
Lower Extremity                      CPT:  73721
MRI - Lumber w/o contrast      CPT:  72148

Current Procedural Terminology (CPT) codes are numbers that are often used on medical bills to identify the charge for each service and procedure billed by a provider to you and/or your health insurance plan. 

Other Resources

Healthcare Financial Management Association
Understanding Healthcare Prices: A Consumer Guide

Call for an Estimate

As our call volumes vary, a call back after submitting a web form will allow you to avoid time on hold.  The web form submission will also allow for time to begin processing your request prior to our call.

If you do not wish to submit a web form, but would like to speak with someone now, please call 777-8202.  

Patient Name  *Date of Birth  *Gender Insurance carrier  *Insurance ID Number  *CPT Code (Procedure Code)

Please see example CPT Codes above. Ask your provider for the appropriate CPT codes. 
Phone Number  *The best time of day to call: 

St. Mary's Health System • 93 Campus Avenue • Lewiston, ME 04240