| Procedure | Androscoggin Valley Hospital | Bridgton Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $49 | $183 | $51 |
| Abdominal ultrasound | $554 | $321 | $100 |
| Abdominal ultrasound (complete) | $631 | $433 | $114 |
| Abdominal ultrasound (limited) | $478 | $208 | $86 |
| Albumin blood test | $44 | $14 | $5 |
| Aldosterone test | $257 | $179 | $41 |
| Alkaline phosphatase test | $33 | $25 | $5 |
| Alpha-fetoprotein (AFP) test | $60 | $85 | $17 |
| ALT liver enzyme test | $20 | $27 | $5 |
| Ammonia blood test | $53 | $94 | $15 |
| Amylase test | $24 | $47 | $6 |
| Antinuclear antibody (ANA) test | $44 | $59 | $12 |
| AST liver enzyme test | $19 | $20 | $5 |
| Barium swallow study | $513 | $355 | $107 |
| Basic metabolic panel | $54 | $70 | $8 |
| Bilirubin blood test | $19 | $51 | $5 |
| Blood clotting test (PT/INR) | $40 | $30 | $4 |
| Blood crossmatch | $164 | $32 | — |
| Blood glucose test | $16 | $25 | $5 |
| Blood transfusion | $868 | $497 | $47 |
| Blood type and screen | $124 | $64 | $10 |
| Blood type test | $11 | $18 | $3 |
| Blood type test (ABO group) | $11 | $19 | $3 |
| Blood type test (Rh/D antigen) | $11 | $17 | $3 |
| BNP (heart failure) test | $142 | $207 | $39 |
| Bone density scan (DEXA) | $471 | $256 | $39 |
| Bone scan (nuclear) | $1,328 | $453 | $259 |
| Breast biopsy | $1,453 | $1,815 | $478 |
| Breast MRI | $3,083 | $382 | $216 |
| Breast ultrasound | $389 | $189 | $92 |
| Breast ultrasound (limited) | $389 | $189 | $84 |
| C-reactive protein (CRP) | $64 | $45 | $5 |
| CA 19-9 tumor marker test | $132 | $43 | $21 |
| CA-125 ovarian marker test | $132 | $90 | $21 |
| Calcium blood test | $19 | $11 | $5 |
| Carotid artery ultrasound | $885 | $572 | $156 |
| CEA tumor marker test | $121 | $91 | $19 |
| Chemotherapy infusion | $393 | $273 | $81 |
| Chemotherapy infusion (each additional) | $154 | $96 | $28 |
| Chemotherapy infusion (first hour) | $632 | $449 | $133 |
| Chest X-ray | $206 | $98 | $37 |
| Chest X-ray (1 view) | $175 | $98 | $25 |
| Chest X-ray (2 views) | $238 | $98 | $33 |
| CK-MB heart enzyme test | $67 | $81 | $12 |
| Clotting time test (PTT) | $23 | $45 | $6 |
| Complete blood count (CBC) | $45 | $34 | $7 |
| Complete blood count (CBC) (complete) | $44 | $36 | $8 |
| Comprehensive metabolic panel | $96 | $104 | $11 |
| Copper blood test | $46 | $42 | $12 |
| Cortisol test | $103 | $69 | $16 |
| COVID-19 PCR test | $73 | $56 | $51 |
| Creatine kinase (CK) test | $42 | $52 | $7 |
| CT angiography of the chest | $2,374 | $815 | $281 |
| CT angiography of the head | $2,191 | $592 | $274 |
| CT scan of the abdomen | $1,666 | $1,068 | $230 |
| CT scan of the abdomen and pelvis | $2,989 | $1,072 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $3,183 | $1,209 | $338 |
| CT scan of the abdomen and pelvis with contrast | $2,989 | $1,072 | $300 |
| CT scan of the abdomen and pelvis without contrast | $2,795 | $748 | $183 |
| CT scan of the abdomen with and without contrast | $1,911 | $1,209 | $259 |
| CT scan of the abdomen with contrast | $1,666 | $1,068 | $230 |
| CT scan of the abdomen without contrast | $1,472 | $673 | $136 |
| CT scan of the arm | $1,569 | $622 | $199 |
| CT scan of the arm with contrast | $1,666 | $622 | $199 |
| CT scan of the arm without contrast | $1,472 | $582 | $161 |
| CT scan of the chest | $1,569 | $981 | $167 |
| CT scan of the chest with contrast | $1,666 | $981 | $167 |
| CT scan of the chest without contrast | $1,472 | $762 | $133 |
| CT scan of the head | $1,666 | $725 | $148 |
| CT scan of the head with and without contrast | $1,860 | $873 | $173 |
| CT scan of the head with contrast | $1,666 | $725 | $148 |
| CT scan of the head without contrast | $1,472 | $604 | $107 |
| CT scan of the leg | $1,569 | $672 | $166 |
| CT scan of the leg with contrast | $1,666 | $672 | $166 |
| CT scan of the leg without contrast | $1,472 | $672 | $130 |
| CT scan of the lower back (lumbar spine) | $1,472 | $786 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $1,472 | $737 | $130 |
| CT scan of the neck | $1,569 | $816 | $183 |
| CT scan of the neck (cervical spine) | $1,516 | $660 | $168 |
| CT scan of the neck (cervical spine) with contrast | $1,561 | $1,009 | $168 |
| CT scan of the neck (cervical spine) without contrast | $1,472 | $660 | $131 |
| CT scan of the neck with contrast | $1,666 | $816 | $183 |
| CT scan of the neck without contrast | $1,472 | $505 | $150 |
| CT scan of the pelvis | $1,666 | $751 | $226 |
| CT scan of the pelvis with and without contrast | $1,860 | $1,034 | $251 |
| CT scan of the pelvis with contrast | $1,666 | $751 | $226 |
| CT scan of the pelvis without contrast | $1,472 | $689 | $133 |
| CT scan of the sinuses | $1,569 | $613 | $152 |
| CT scan of the sinuses with contrast | $1,666 | $613 | $152 |
| CT scan of the sinuses without contrast | $1,472 | $439 | $128 |
| DHEA-sulfate test | $81 | $116 | $22 |
| Diagnostic mammogram | $650 | $194 | $140 |
| Drug screen (urine) | $121 | $61 | $17 |
| Echocardiogram | $1,729 | $781 | $138 |
| Electrolyte panel | $53 | $36 | $7 |
| Emergency department visit | $272 | $332 | $69 |
| Emergency department visit (level 1) | $157 | $97 | $11 |
| Emergency department visit (level 2) | $174 | $162 | $40 |
| Emergency department visit (level 3) | $305 | $332 | $69 |
| Emergency department visit (level 4) | $487 | $608 | $118 |
| Emergency department visit (level 5) | $701 | $986 | $171 |
| Estradiol (estrogen) test | $101 | $108 | $28 |
| Fecal occult blood (stool) test | $58 | $30 | $10 |
| Fecal occult blood (stool) test (guaiac, gFOBT) | $15 | $23 | $4 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $101 | $36 | $16 |
| Ferritin (iron) test | $114 | $65 | $14 |
| Fibrinogen test | $36 | $51 | $10 |
| Folate (folic acid) test | $54 | $56 | $15 |
| Free T4 thyroid test | $101 | $78 | $9 |
| FSH hormone test | $118 | $82 | $19 |
| Gallbladder scan (HIDA) | $1,807 | $505 | $334 |
| GGT liver test | $47 | $46 | $7 |
| Glucose tolerance test | $31 | $43 | $8 |
| HDL cholesterol test | $30 | $54 | $8 |
| Hematocrit test | $9 | $13 | $2 |
| Hemoglobin A1c (diabetes test) | $62 | $54 | $10 |
| Hepatitis B test | $38 | $42 | $10 |
| Hepatitis C test | $52 | $81 | $14 |
| HIV test | $97 | $35 | $19 |
| HIV test (antibody) | $50 | $35 | $14 |
| Iron blood test | $42 | $30 | $6 |
| IV infusion therapy | $238 | $220 | $44 |
| IV infusion therapy (each additional) | $129 | $125 | $21 |
| IV infusion therapy (initial) | $348 | $315 | $67 |
| Kidney scan (nuclear) | $1,319 | $460 | $172 |
| Kidney ultrasound | $490 | $289 | $84 |
| Kidney ultrasound (limited) | $463 | $210 | $61 |
| Lactate test | $42 | $53 | $12 |
| LDH test | $39 | $39 | $6 |
| LDL cholesterol test | $60 | $39 | $11 |
| Leg vein ultrasound (Doppler) | $1,032 | $501 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $931 | $501 | $116 |
| LH hormone test | $67 | $89 | $19 |
| Lipase test | $58 | $36 | $7 |
| Lipid (cholesterol) panel | $137 | $76 | $13 |
| Liver function panel | $61 | $88 | $8 |
| Lung function test (PFT) | $119 | $155 | $37 |
| Magnesium blood test | $54 | $33 | $7 |
| MRA of the brain | $2,575 | $754 | $226 |
| MRA of the brain with contrast | $2,575 | $754 | $226 |
| MRA of the brain without contrast | $2,885 | $1,142 | $328 |
| MRA of the neck | $2,752 | $675 | $245 |
| MRA of the neck with contrast | $2,426 | $675 | $245 |
| MRA of the neck without contrast | $3,079 | $952 | $343 |
| MRI of the abdomen | $3,319 | $836 | $300 |
| MRI of the abdomen without contrast | $2,779 | $600 | $194 |
| MRI of the ankle | $3,102 | $836 | $261 |
| MRI of the ankle without contrast | $2,344 | $771 | $222 |
| MRI of the brain | $3,190 | $698 | $269 |
| MRI of the brain without contrast | $2,566 | $675 | $195 |
| MRI of the knee | $3,114 | $1,029 | $315 |
| MRI of the knee without contrast | $2,316 | $893 | $204 |
| MRI of the lower back (lumbar spine) | $3,229 | $827 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $2,754 | $827 | $192 |
| MRI of the mid-back (thoracic spine) | $3,113 | $809 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $3,472 | $990 | $319 |
| MRI of the mid-back (thoracic spine) without contrast | $2,754 | $809 | $190 |
| MRI of the neck (cervical spine) | $3,113 | $864 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $3,472 | $957 | $318 |
| MRI of the neck (cervical spine) without contrast | $2,754 | $746 | $191 |
| MRI of the pelvis | $3,136 | $836 | $268 |
| MRI of the pelvis without contrast | $2,806 | $834 | $227 |
| MRI of the shoulder | $2,401 | $858 | $313 |
| MRI of the shoulder with contrast | $2,401 | $858 | $313 |
| MRI of the shoulder without contrast | $2,207 | $827 | $205 |
| MRI of the wrist | $2,207 | $836 | $330 |
| MRI of the wrist without contrast | $2,207 | $724 | $303 |
| Nuclear cardiac stress test | $3,227 | $1,543 | $428 |
| Occupational therapy evaluation | $258 | $194 | $101 |
| Occupational therapy evaluation (low complexity) | $243 | $194 | $101 |
| Occupational therapy evaluation (moderate complexity) | $273 | $194 | $101 |
| Office visit (established patient) | $132 | $84 | $115 |
| Office visit, established patient (level 3) | $107 | $78 | $95 |
| Office visit, established patient (level 4) | $158 | $90 | $136 |
| Pap smear (cervical screening) | $159 | $56 | $20 |
| Parathyroid hormone (PTH) test | $260 | $104 | $41 |
| Pelvic ultrasound | $435 | $288 | $78 |
| Pelvic ultrasound (complete) | $511 | $365 | $105 |
| Pelvic ultrasound (limited) | $358 | $210 | $51 |
| Phosphorus blood test | $18 | $18 | $5 |
| Physical therapy evaluation | $273 | $163 | $98 |
| Physical therapy evaluation (high complexity) | $309 | $163 | $98 |
| Physical therapy evaluation (moderate complexity) | $273 | $163 | $98 |
| Platelet count | $17 | $23 | $4 |
| Pregnancy blood test (hCG) | $28 | $36 | $8 |
| Pregnancy ultrasound | $559 | $323 | $126 |
| Pregnancy ultrasound (first trimester) | $497 | $299 | $117 |
| Pregnancy ultrasound (second or third trimester) | $620 | $347 | $136 |
| Prolactin test | $70 | $75 | $19 |
| Prostate test (PSA) | $67 | $71 | $18 |
| Scoliosis spine X-ray | $340 | $177 | $58 |
| Scoliosis spine X-ray (3 views) | $340 | $221 | $72 |
| Screening mammogram | $607 | $206 | $126 |
| Scrotal ultrasound | $463 | $322 | $99 |
| Sedimentation rate (ESR) test | $11 | $31 | $3 |
| Semen analysis | $44 | $30 | $12 |
| Sex hormone binding globulin test | $79 | $42 | $22 |
| Simple laceration repair (small, up to 2.5 cm) | $348 | $133 | $114 |
| Simple wound stitches | $358 | $133 | $127 |
| Soft tissue ultrasound | $299 | $166 | $64 |
| Speech therapy | $225 | $141 | $76 |
| Spirometry (lung function test) | $44 | $131 | $30 |
| Spirometry with bronchodilator | $193 | $178 | $43 |
| Swallow study | $202 | $192 | $85 |
| T3 thyroid test | $52 | $60 | $14 |
| Testosterone test | $94 | $107 | $26 |
| Thyroid test (TSH) | $124 | $81 | $17 |
| Thyroid ultrasound | $540 | $331 | $109 |
| Total protein test | $25 | $29 | $4 |
| Transvaginal ultrasound | $590 | $222 | $118 |
| Triglycerides test | $21 | $47 | $6 |
| Troponin (heart) test | $121 | $76 | $12 |
| Upper GI series (barium) | $578 | $393 | $128 |
| Uric acid (gout) test | $17 | $24 | $5 |
| Urinalysis | $26 | $21 | $3 |
| Urine microalbumin test | $59 | $40 | $5 |
| Urine pregnancy test | $32 | $29 | $9 |
| Vaccine administration | $35 | $8 | $19 |
| Vitamin B12 test | $90 | $84 | $15 |
| Vitamin D test | $210 | $43 | $30 |
| X-ray of the abdomen | $243 | $238 | $36 |
| X-ray of the ankle | $278 | $149 | $37 |
| X-ray of the collarbone | $254 | $129 | $33 |
| X-ray of the elbow | $278 | $165 | $33 |
| X-ray of the facial bones | $341 | $148 | $39 |
| X-ray of the foot | $315 | $152 | $34 |
| X-ray of the forearm | $245 | $136 | $29 |
| X-ray of the hand | $282 | $159 | $38 |
| X-ray of the hip | $310 | $134 | $49 |
| X-ray of the hip (1 view) | $251 | $135 | $34 |
| X-ray of the hip (3 views) | $368 | $133 | $49 |
| X-ray of the knee | $347 | $174 | $42 |
| X-ray of the knee (2 views) | $278 | $68 | $34 |
| X-ray of the knee (3 views) | $389 | $174 | $42 |
| X-ray of the knee (4+ views) | $347 | $195 | $49 |
| X-ray of the lower back (lumbar spine) | $347 | $245 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $290 | $218 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $403 | $272 | $53 |
| X-ray of the lower leg | $248 | $152 | $31 |
| X-ray of the mid-back (thoracic spine) | $284 | $184 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $278 | $188 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $290 | $180 | $39 |
| X-ray of the neck (cervical spine) | $314 | $212 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $268 | $180 | $40 |
| X-ray of the pelvis | $305 | $208 | $36 |
| X-ray of the pelvis (1 view) | $282 | $224 | $28 |
| X-ray of the ribs | $268 | $213 | $42 |
| X-ray of the ribs (2 views) | $268 | $165 | $36 |
| X-ray of the shoulder | $260 | $166 | $36 |
| X-ray of the skull | $290 | $196 | $40 |
| X-ray of the upper arm | $251 | $160 | $32 |
| X-ray of the wrist | $251 | $151 | $43 |
| Zinc blood test | $42 | $35 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
