| Procedure | Mainehealth Franklin Hospital | Androscoggin Valley Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $337 | $49 | $51 |
| Abdominal fluid drain (paracentesis) | $1,805 | $825 | $284 |
| Abdominal ultrasound | $538 | $554 | $100 |
| Abdominal ultrasound (complete) | $700 | $631 | $114 |
| Abdominal ultrasound (limited) | $538 | $478 | $86 |
| Abscess drainage (complex or multiple) | $452 | $294 | $220 |
| Abscess drainage (simple) | $430 | $191 | $129 |
| Abscess incision and drainage | $441 | $224 | $174 |
| Albumin blood test | $34 | $44 | $5 |
| Aldosterone test | $329 | $257 | $41 |
| Alkaline phosphatase test | $81 | $33 | $5 |
| Alpha-fetoprotein (AFP) test | $99 | $60 | $17 |
| ALT liver enzyme test | $62 | $20 | $5 |
| Ammonia blood test | $159 | $53 | $15 |
| Amylase test | $72 | $24 | $6 |
| Antinuclear antibody (ANA) test | $133 | $44 | $12 |
| AST liver enzyme test | $60 | $19 | $5 |
| Barium swallow study | $750 | $513 | $107 |
| Basic metabolic panel | $96 | $54 | $8 |
| Bilirubin blood test | $56 | $19 | $5 |
| Blood clotting test (PT/INR) | $47 | $40 | $4 |
| Blood crossmatch | $55 | $164 | — |
| Blood glucose test | $38 | $16 | $5 |
| Blood transfusion | $1,550 | $868 | $47 |
| Blood type and screen | $116 | $124 | $10 |
| Blood type test | $34 | $11 | $3 |
| Blood type test (ABO group) | $34 | $11 | $3 |
| Blood type test (Rh/D antigen) | $34 | $11 | $3 |
| BNP (heart failure) test | $368 | $142 | $39 |
| Bone density scan (DEXA) | $457 | $471 | $39 |
| Bone scan (nuclear) | $1,476 | $1,328 | $259 |
| Botox for migraine | $834 | $300 | $157 |
| Breast biopsy | $4,324 | $1,453 | $478 |
| Breast MRI | $1,459 | $3,083 | $216 |
| Breast ultrasound | $386 | $389 | $92 |
| Breast ultrasound (limited) | $499 | $389 | $84 |
| Breathing tube insertion (intubation) | $466 | $230 | $133 |
| Burn dressing and debridement (small) | $418 | $156 | $93 |
| Burn treatment | $366 | $156 | $129 |
| C-reactive protein (CRP) | $59 | $64 | $5 |
| CA 19-9 tumor marker test | $227 | $132 | $21 |
| CA-125 ovarian marker test | $227 | $132 | $21 |
| Calcium blood test | $60 | $19 | $5 |
| Cardiac rehabilitation | $218 | $188 | $26 |
| Cardiac stress test | $1,606 | $836 | $39 |
| Cardioversion | $2,130 | $482 | $155 |
| Carotid artery ultrasound | $510 | $885 | $156 |
| CEA tumor marker test | $208 | $121 | $19 |
| Celiac disease test | $82 | $42 | $12 |
| Central line placement | $2,354 | $1,033 | $238 |
| Chemotherapy infusion | $542 | $393 | $81 |
| Chemotherapy infusion (each additional) | $542 | $154 | $28 |
| Chemotherapy infusion (first hour) | $542 | $632 | $133 |
| Chest X-ray | $295 | $206 | $37 |
| Chest X-ray (1 view) | $183 | $175 | $25 |
| Chest X-ray (2 views) | $253 | $238 | $33 |
| CK-MB heart enzyme test | $88 | $67 | $12 |
| Clotting time test (PTT) | $67 | $23 | $6 |
| Complete blood count (CBC) | $80 | $45 | $7 |
| Complete blood count (CBC) (complete) | $88 | $44 | $8 |
| Comprehensive metabolic panel | $119 | $96 | $11 |
| Copper blood test | $121 | $46 | $12 |
| Cortisol test | $179 | $103 | $16 |
| COVID-19 PCR test | $86 | $73 | $51 |
| CPAP titration study | $318 | $441 | $69 |
| Creatine kinase (CK) test | $72 | $42 | $7 |
| CT angiography of the chest | $2,586 | $2,374 | $281 |
| CT angiography of the head | $2,586 | $2,191 | $274 |
| CT scan of the abdomen | $2,191 | $1,666 | $230 |
| CT scan of the abdomen and pelvis | $1,961 | $2,989 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $2,590 | $3,183 | $338 |
| CT scan of the abdomen and pelvis with contrast | $1,961 | $2,989 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,029 | $2,795 | $183 |
| CT scan of the abdomen with and without contrast | $2,503 | $1,911 | $259 |
| CT scan of the abdomen with contrast | $2,191 | $1,666 | $230 |
| CT scan of the abdomen without contrast | $1,430 | $1,472 | $136 |
| CT scan of the arm | $1,945 | $1,569 | $199 |
| CT scan of the arm with contrast | $1,945 | $1,666 | $199 |
| CT scan of the arm without contrast | $1,430 | $1,472 | $161 |
| CT scan of the chest | $2,049 | $1,569 | $167 |
| CT scan of the chest with contrast | $2,049 | $1,666 | $167 |
| CT scan of the chest without contrast | $1,430 | $1,472 | $133 |
| CT scan of the head | $1,653 | $1,666 | $148 |
| CT scan of the head with and without contrast | $2,033 | $1,860 | $173 |
| CT scan of the head with contrast | $1,653 | $1,666 | $148 |
| CT scan of the head without contrast | $1,287 | $1,472 | $107 |
| CT scan of the leg | $1,960 | $1,569 | $166 |
| CT scan of the leg with contrast | $1,960 | $1,666 | $166 |
| CT scan of the leg without contrast | $1,430 | $1,472 | $130 |
| CT scan of the lower back (lumbar spine) | $2,049 | $1,472 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $1,430 | $1,472 | $130 |
| CT scan of the neck | $1,934 | $1,569 | $183 |
| CT scan of the neck (cervical spine) | $2,050 | $1,516 | $168 |
| CT scan of the neck (cervical spine) with contrast | $2,050 | $1,561 | $168 |
| CT scan of the neck (cervical spine) without contrast | $1,430 | $1,472 | $131 |
| CT scan of the neck with contrast | $1,934 | $1,666 | $183 |
| CT scan of the neck without contrast | $1,430 | $1,472 | $150 |
| CT scan of the pelvis | $1,949 | $1,666 | $226 |
| CT scan of the pelvis with and without contrast | $2,505 | $1,860 | $251 |
| CT scan of the pelvis with contrast | $1,949 | $1,666 | $226 |
| CT scan of the pelvis without contrast | $1,430 | $1,472 | $133 |
| CT scan of the sinuses | $2,003 | $1,569 | $152 |
| CT scan of the sinuses with contrast | $2,003 | $1,666 | $152 |
| CT scan of the sinuses without contrast | $1,430 | $1,472 | $128 |
| D-dimer test | $81 | $38 | $10 |
| DHEA-sulfate test | $212 | $81 | $22 |
| Diagnostic mammogram | $446 | $650 | $140 |
| Drug screen (urine) | $66 | $121 | $17 |
| Echocardiogram | $940 | $1,729 | $138 |
| EKG / ECG (tracing only) | $227 | $207 | $7 |
| Electrocardiogram (EKG) | $227 | $110 | $8 |
| Electrolyte panel | $81 | $53 | $7 |
| Emergency department visit | $449 | $272 | $69 |
| Emergency department visit (level 1) | $332 | $157 | $11 |
| Emergency department visit (level 2) | $414 | $174 | $40 |
| Emergency department visit (level 3) | $558 | $305 | $69 |
| Emergency department visit (level 4) | $921 | $487 | $118 |
| Emergency department visit (level 5) | $1,142 | $701 | $171 |
| Epidural steroid injection | $2,114 | $926 | $275 |
| Estradiol (estrogen) test | $297 | $101 | $28 |
| Facet joint injection (spine) | $546 | $574 | $99 |
| Fecal occult blood (stool) test | $35 | $58 | $10 |
| Fecal occult blood (stool) test (guaiac, gFOBT) | $17 | $15 | $4 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $35 | $101 | $16 |
| Ferritin (iron) test | $150 | $114 | $14 |
| Fibrinogen test | $96 | $36 | $10 |
| Flu test | $79 | $81 | $17 |
| Folate (folic acid) test | $160 | $54 | $15 |
| Foreign body removal (skin) | $675 | $307 | $157 |
| Free T4 thyroid test | $100 | $101 | $9 |
| FSH hormone test | $200 | $118 | $19 |
| Gallbladder scan (HIDA) | $1,719 | $1,807 | $334 |
| GGT liver test | $81 | $47 | $7 |
| Glucose tolerance test | $88 | $31 | $8 |
| HDL cholesterol test | $93 | $30 | $8 |
| Hematocrit test | $28 | $9 | $2 |
| Hemoglobin A1c (diabetes test) | $103 | $62 | $10 |
| Hepatitis B test | $115 | $38 | $10 |
| Hepatitis C test | $252 | $52 | $14 |
| HIV test | $165 | $97 | $19 |
| HIV test (antibody) | $116 | $50 | $14 |
| HIV test (antigen/antibody combo) | $213 | $144 | $24 |
| Iron blood test | $72 | $42 | $6 |
| IUD removal | $511 | $575 | $112 |
| IV infusion therapy | $465 | $238 | $44 |
| IV infusion therapy (each additional) | $465 | $129 | $21 |
| IV infusion therapy (initial) | $489 | $348 | $67 |
| Joint aspiration (small/intermediate) | $278 | $121 | $57 |
| Joint aspiration or injection (mid-size joint) | $182 | $174 | $57 |
| Joint aspiration or injection (small joint) | $929 | $67 | $56 |
| Kidney scan (nuclear) | $963 | $1,319 | $172 |
| Kidney ultrasound | $596 | $490 | $84 |
| Kidney ultrasound (limited) | $596 | $463 | $61 |
| Knee joint injection | $1,003 | $92 | $69 |
| Lactate test | $119 | $42 | $12 |
| LDH test | $67 | $39 | $6 |
| LDL cholesterol test | $86 | $60 | $11 |
| Leg vein ultrasound (Doppler) | $926 | $1,032 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $795 | $931 | $116 |
| LH hormone test | $200 | $67 | $19 |
| Lipase test | $78 | $58 | $7 |
| Lipid (cholesterol) panel | $147 | $137 | $13 |
| Liver function panel | $93 | $61 | $8 |
| Lung function test (PFT) | $227 | $119 | $37 |
| Magnesium blood test | $77 | $54 | $7 |
| MRA of the brain | $3,137 | $2,575 | $226 |
| MRA of the brain with contrast | $3,137 | $2,575 | $226 |
| MRA of the brain without contrast | $3,955 | $2,885 | $328 |
| MRA of the neck | $3,137 | $2,752 | $245 |
| MRA of the neck with contrast | $3,137 | $2,426 | $245 |
| MRA of the neck without contrast | $3,955 | $3,079 | $343 |
| MRI of the abdomen | $3,137 | $3,319 | $300 |
| MRI of the abdomen without contrast | $2,555 | $2,779 | $194 |
| MRI of the ankle | $3,137 | $3,102 | $261 |
| MRI of the ankle without contrast | $2,555 | $2,344 | $222 |
| MRI of the brain | $3,137 | $3,190 | $269 |
| MRI of the brain without contrast | $2,560 | $2,566 | $195 |
| MRI of the knee | $3,137 | $3,114 | $315 |
| MRI of the knee without contrast | $2,555 | $2,316 | $204 |
| MRI of the lower back (lumbar spine) | $3,137 | $3,229 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $2,555 | $2,754 | $192 |
| MRI of the mid-back (thoracic spine) | $3,137 | $3,113 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $3,956 | $3,472 | $319 |
| MRI of the mid-back (thoracic spine) without contrast | $2,555 | $2,754 | $190 |
| MRI of the neck (cervical spine) | $3,137 | $3,113 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $3,956 | $3,472 | $318 |
| MRI of the neck (cervical spine) without contrast | $2,555 | $2,754 | $191 |
| MRI of the pelvis | $3,137 | $3,136 | $268 |
| MRI of the pelvis without contrast | $2,555 | $2,806 | $227 |
| MRI of the shoulder | $3,137 | $2,401 | $313 |
| MRI of the shoulder with contrast | $3,137 | $2,401 | $313 |
| MRI of the shoulder without contrast | $2,555 | $2,207 | $205 |
| MRI of the wrist | $3,140 | $2,207 | $330 |
| MRI of the wrist without contrast | $2,555 | $2,207 | $303 |
| Nebulizer breathing treatment | $367 | $145 | $9 |
| Nuclear cardiac stress test | $2,207 | $3,227 | $428 |
| Occupational therapy evaluation | $484 | $258 | $101 |
| Occupational therapy evaluation (low complexity) | $437 | $243 | $101 |
| Occupational therapy evaluation (moderate complexity) | $484 | $273 | $101 |
| Office visit (established patient) | $308 | $132 | $115 |
| Office visit (new patient) | $511 | $122 | $177 |
| Office visit, established patient (level 3) | $303 | $107 | $95 |
| Office visit, established patient (level 4) | $460 | $158 | $136 |
| Office visit, new patient (level 3) | $348 | $98 | $118 |
| Office visit, new patient (level 4) | $511 | $146 | $177 |
| Pap smear (cervical screening) | $200 | $159 | $20 |
| Parathyroid hormone (PTH) test | $446 | $260 | $41 |
| Pelvic ultrasound | $465 | $435 | $78 |
| Pelvic ultrasound (complete) | $630 | $511 | $105 |
| Pelvic ultrasound (limited) | $465 | $358 | $51 |
| Phosphorus blood test | $54 | $18 | $5 |
| Physical therapy evaluation | $480 | $273 | $98 |
| Physical therapy evaluation (high complexity) | $529 | $309 | $98 |
| Physical therapy evaluation (moderate complexity) | $480 | $273 | $98 |
| Platelet count | $53 | $17 | $4 |
| Pregnancy blood test (hCG) | $70 | $28 | $8 |
| Pregnancy ultrasound | $596 | $559 | $126 |
| Pregnancy ultrasound (first trimester) | $596 | $497 | $117 |
| Pregnancy ultrasound (second or third trimester) | $708 | $620 | $136 |
| Procalcitonin test | $151 | $99 | $27 |
| Prolactin test | $210 | $70 | $19 |
| Prostate test (PSA) | $200 | $67 | $18 |
| Radiofrequency nerve ablation | $5,516 | $2,410 | $462 |
| Sacroiliac joint injection | $1,376 | $547 | $176 |
| Scoliosis spine X-ray | $305 | $340 | $58 |
| Scoliosis spine X-ray (3 views) | $504 | $340 | $72 |
| Screening mammogram | $399 | $607 | $126 |
| Scrotal ultrasound | $635 | $463 | $99 |
| Sedimentation rate (ESR) test | $42 | $11 | $3 |
| Semen analysis | $133 | $44 | $12 |
| Sex hormone binding globulin test | $172 | $79 | $22 |
| Simple laceration repair (small, up to 2.5 cm) | $293 | $348 | $114 |
| Simple wound stitches | $293 | $358 | $127 |
| Soft tissue ultrasound | $151 | $299 | $64 |
| Speech therapy | $334 | $225 | $76 |
| Spirometry (lung function test) | $227 | $44 | $30 |
| Spirometry with bronchodilator | $468 | $193 | $43 |
| Stress echocardiogram | $1,802 | $1,271 | $209 |
| Swallow study | $480 | $202 | $85 |
| T3 thyroid test | $155 | $52 | $14 |
| Testosterone test | $240 | $94 | $26 |
| Thyroid test (TSH) | $183 | $124 | $17 |
| Thyroid ultrasound | $604 | $540 | $109 |
| Total IgE allergy test | $181 | $60 | $16 |
| Total protein test | $44 | $25 | $4 |
| Transesophageal echocardiogram (TEE) | $3,795 | $1,346 | $239 |
| Transesophageal echocardiogram (TEE) with and without contrast | $3,795 | $1,346 | $239 |
| Transvaginal ultrasound | $626 | $590 | $118 |
| Trigger point injection | $413 | $83 | $56 |
| Triglycerides test | $66 | $21 | $6 |
| Troponin (heart) test | $109 | $121 | $12 |
| Upper GI series (barium) | $855 | $578 | $128 |
| Uric acid (gout) test | $53 | $17 | $5 |
| Urinalysis | $24 | $26 | $3 |
| Urine microalbumin test | $56 | $59 | $5 |
| Urine pregnancy test | $60 | $32 | $9 |
| Vaccine administration | $28 | $35 | $19 |
| Vitamin B12 test | $164 | $90 | $15 |
| Vitamin D test | $320 | $210 | $30 |
| X-ray of the abdomen | $318 | $243 | $36 |
| X-ray of the ankle | $263 | $278 | $37 |
| X-ray of the collarbone | $229 | $254 | $33 |
| X-ray of the elbow | $307 | $278 | $33 |
| X-ray of the facial bones | $309 | $341 | $39 |
| X-ray of the foot | $260 | $315 | $34 |
| X-ray of the forearm | $229 | $245 | $29 |
| X-ray of the hand | $263 | $282 | $38 |
| X-ray of the hip | $305 | $310 | $49 |
| X-ray of the hip (1 view) | $305 | $251 | $34 |
| X-ray of the hip (3 views) | $305 | $368 | $49 |
| X-ray of the knee | $236 | $347 | $42 |
| X-ray of the knee (2 views) | $236 | $278 | $34 |
| X-ray of the knee (3 views) | $295 | $389 | $42 |
| X-ray of the knee (4+ views) | $338 | $347 | $49 |
| X-ray of the lower back (lumbar spine) | $330 | $347 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $330 | $290 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $461 | $403 | $53 |
| X-ray of the lower leg | $221 | $248 | $31 |
| X-ray of the mid-back (thoracic spine) | $274 | $284 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $274 | $278 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $330 | $290 | $39 |
| X-ray of the neck (cervical spine) | $307 | $314 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $307 | $268 | $40 |
| X-ray of the pelvis | $209 | $305 | $36 |
| X-ray of the pelvis (1 view) | $209 | $282 | $28 |
| X-ray of the ribs | $313 | $268 | $42 |
| X-ray of the ribs (2 views) | $260 | $268 | $36 |
| X-ray of the shoulder | $248 | $260 | $36 |
| X-ray of the skull | $293 | $290 | $40 |
| X-ray of the upper arm | $248 | $251 | $32 |
| X-ray of the wrist | $301 | $251 | $43 |
| Zinc blood test | $81 | $42 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
