| Procedure | Mainehealth Franklin Hospital | Rumford Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $337 | $172 | $51 |
| Abdominal ultrasound | $538 | $300 | $100 |
| Abdominal ultrasound (complete) | $700 | $405 | $114 |
| Abdominal ultrasound (limited) | $538 | $194 | $86 |
| Albumin blood test | $34 | $13 | $5 |
| Aldosterone test | $329 | $168 | $41 |
| Alkaline phosphatase test | $81 | $24 | $5 |
| Alpha-fetoprotein (AFP) test | $99 | $79 | $17 |
| ALT liver enzyme test | $62 | $26 | $5 |
| Ammonia blood test | $159 | $88 | $15 |
| Amylase test | $72 | $44 | $6 |
| Antinuclear antibody (ANA) test | $133 | $55 | $12 |
| Arterial blood gas (ABG) | $210 | $108 | $26 |
| AST liver enzyme test | $60 | $19 | $5 |
| Barium swallow study | $750 | $332 | $107 |
| Basic metabolic panel | $96 | $65 | $8 |
| Bilirubin blood test | $56 | $48 | $5 |
| Blood clotting test (PT/INR) | $47 | $28 | $4 |
| Blood crossmatch | $55 | $30 | — |
| Blood glucose test | $38 | $24 | $5 |
| Blood transfusion | $1,550 | $465 | $47 |
| Blood type and screen | $116 | $60 | $10 |
| Blood type test | $34 | $17 | $3 |
| Blood type test (ABO group) | $34 | $17 | $3 |
| Blood type test (Rh/D antigen) | $34 | $16 | $3 |
| BNP (heart failure) test | $368 | $193 | $39 |
| Bone density scan (DEXA) | $457 | $240 | $39 |
| Bone scan (nuclear) | $1,476 | $423 | $259 |
| Breast biopsy | $4,324 | $1,698 | $478 |
| Breast MRI | $1,459 | $358 | $216 |
| Breast ultrasound | $386 | $177 | $92 |
| Breast ultrasound (complete) | $386 | $177 | $100 |
| Breast ultrasound (limited) | $499 | $177 | $84 |
| Breathing tube insertion (intubation) | $466 | $243 | $133 |
| C-reactive protein (CRP) | $59 | $42 | $5 |
| CA 19-9 tumor marker test | $227 | $40 | $21 |
| CA-125 ovarian marker test | $227 | $85 | $21 |
| Calcium blood test | $60 | $10 | $5 |
| Cardiac rehabilitation | $218 | $46 | $26 |
| Carotid artery ultrasound | $510 | $535 | $156 |
| CEA tumor marker test | $208 | $85 | $19 |
| Chemotherapy infusion | $542 | $255 | $81 |
| Chemotherapy infusion (each additional) | $542 | $90 | $28 |
| Chemotherapy infusion (first hour) | $542 | $420 | $133 |
| Chest X-ray | $295 | $92 | $37 |
| Chest X-ray (1 view) | $183 | $92 | $25 |
| Chest X-ray (2 views) | $253 | $92 | $33 |
| CK-MB heart enzyme test | $88 | $76 | $12 |
| Clotting time test (PTT) | $67 | $42 | $6 |
| Complete blood count (CBC) | $80 | $32 | $7 |
| Complete blood count (CBC) (complete) | $88 | $34 | $8 |
| Comprehensive metabolic panel | $119 | $97 | $11 |
| Copper blood test | $121 | $39 | $12 |
| Cortisol test | $179 | $64 | $16 |
| COVID-19 PCR test | $86 | $52 | $51 |
| Creatine kinase (CK) test | $72 | $48 | $7 |
| CT angiography of the chest | $2,586 | $763 | $281 |
| CT angiography of the head | $2,586 | $553 | $274 |
| CT scan of the abdomen | $2,191 | $999 | $230 |
| CT scan of the abdomen and pelvis | $1,961 | $1,003 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $2,590 | $1,131 | $338 |
| CT scan of the abdomen and pelvis with contrast | $1,961 | $1,003 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,029 | $700 | $183 |
| CT scan of the abdomen with and without contrast | $2,503 | $1,131 | $259 |
| CT scan of the abdomen with contrast | $2,191 | $999 | $230 |
| CT scan of the abdomen without contrast | $1,430 | $629 | $136 |
| CT scan of the arm | $1,945 | $582 | $199 |
| CT scan of the arm with contrast | $1,945 | $582 | $199 |
| CT scan of the arm without contrast | $1,430 | $545 | $161 |
| CT scan of the chest | $2,049 | $917 | $167 |
| CT scan of the chest with and without contrast | $2,505 | $1,140 | $196 |
| CT scan of the chest with contrast | $2,049 | $917 | $167 |
| CT scan of the chest without contrast | $1,430 | $713 | $133 |
| CT scan of the head | $1,653 | $678 | $148 |
| CT scan of the head with and without contrast | $2,033 | $817 | $173 |
| CT scan of the head with contrast | $1,653 | $678 | $148 |
| CT scan of the head without contrast | $1,287 | $565 | $107 |
| CT scan of the leg | $1,960 | $628 | $166 |
| CT scan of the leg with contrast | $1,960 | $628 | $166 |
| CT scan of the leg without contrast | $1,430 | $628 | $130 |
| CT scan of the lower back (lumbar spine) | $2,049 | $735 | $169 |
| CT scan of the lower back (lumbar spine) with and without contrast | $2,505 | $735 | $197 |
| CT scan of the lower back (lumbar spine) with contrast | $2,049 | $756 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $1,430 | $690 | $130 |
| CT scan of the neck | $1,934 | $763 | $183 |
| CT scan of the neck (cervical spine) | $2,050 | $618 | $168 |
| CT scan of the neck (cervical spine) with and without contrast | $2,505 | $553 | $196 |
| CT scan of the neck (cervical spine) with contrast | $2,050 | $944 | $168 |
| CT scan of the neck (cervical spine) without contrast | $1,430 | $618 | $131 |
| CT scan of the neck with and without contrast | $2,435 | $1,044 | $220 |
| CT scan of the neck with contrast | $1,934 | $763 | $183 |
| CT scan of the neck without contrast | $1,430 | $472 | $150 |
| CT scan of the pelvis | $1,949 | $703 | $226 |
| CT scan of the pelvis with and without contrast | $2,505 | $967 | $251 |
| CT scan of the pelvis with contrast | $1,949 | $703 | $226 |
| CT scan of the pelvis without contrast | $1,430 | $645 | $133 |
| CT scan of the sinuses | $2,003 | $573 | $152 |
| CT scan of the sinuses with and without contrast | $2,503 | $724 | $184 |
| CT scan of the sinuses with contrast | $2,003 | $573 | $152 |
| CT scan of the sinuses without contrast | $1,430 | $410 | $128 |
| DHEA-sulfate test | $212 | $109 | $22 |
| Diagnostic mammogram | $446 | $182 | $140 |
| Drug screen (urine) | $66 | $57 | $17 |
| Echocardiogram | $940 | $730 | $138 |
| Echocardiogram with and without contrast | $866 | $542 | $101 |
| Electrolyte panel | $81 | $34 | $7 |
| Emergency department visit | $449 | $311 | $69 |
| Emergency department visit (level 1) | $332 | $91 | $11 |
| Emergency department visit (level 2) | $414 | $151 | $40 |
| Emergency department visit (level 3) | $558 | $311 | $69 |
| Emergency department visit (level 4) | $921 | $568 | $118 |
| Emergency department visit (level 5) | $1,142 | $922 | $171 |
| Estradiol (estrogen) test | $297 | $101 | $28 |
| Fallopian tube X-ray (HSG) | $392 | $359 | $164 |
| Fecal occult blood (stool) test | $35 | $27 | $10 |
| Fecal occult blood (stool) test (guaiac, gFOBT) | $17 | $21 | $4 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $35 | $33 | $16 |
| Ferritin (iron) test | $150 | $61 | $14 |
| Fibrinogen test | $96 | $47 | $10 |
| Folate (folic acid) test | $160 | $53 | $15 |
| Free T4 thyroid test | $100 | $73 | $9 |
| FSH hormone test | $200 | $77 | $19 |
| Gallbladder scan (HIDA) | $1,719 | $473 | $334 |
| GGT liver test | $81 | $43 | $7 |
| Glucose tolerance test | $88 | $40 | $8 |
| HDL cholesterol test | $93 | $51 | $8 |
| Hematocrit test | $28 | $12 | $2 |
| Hemoglobin A1c (diabetes test) | $103 | $51 | $10 |
| Hepatitis B test | $115 | $39 | $10 |
| Hepatitis C test | $252 | $76 | $14 |
| HIV test | $165 | $33 | $19 |
| HIV test (antibody) | $116 | $33 | $14 |
| Iron blood test | $72 | $28 | $6 |
| IV infusion therapy | $465 | $206 | $44 |
| IV infusion therapy (each additional) | $465 | $117 | $21 |
| IV infusion therapy (initial) | $489 | $295 | $67 |
| Kidney scan (nuclear) | $963 | $430 | $172 |
| Kidney ultrasound | $596 | $270 | $84 |
| Kidney ultrasound (limited) | $596 | $196 | $61 |
| Lactate test | $119 | $50 | $12 |
| LDH test | $67 | $36 | $6 |
| LDL cholesterol test | $86 | $37 | $11 |
| Leg vein ultrasound (Doppler) | $926 | $468 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $795 | $468 | $116 |
| LH hormone test | $200 | $83 | $19 |
| Lipase test | $78 | $34 | $7 |
| Lipid (cholesterol) panel | $147 | $71 | $13 |
| Liver function panel | $93 | $83 | $8 |
| Lung function test (PFT) | $227 | $145 | $37 |
| Lung scan (V/Q) | $1,806 | $529 | $291 |
| Magnesium blood test | $77 | $31 | $7 |
| MRA of the brain | $3,137 | $705 | $226 |
| MRA of the brain with contrast | $3,137 | $705 | $226 |
| MRA of the brain without contrast | $3,955 | $1,068 | $328 |
| MRA of the neck | $3,137 | $632 | $245 |
| MRA of the neck with contrast | $3,137 | $632 | $245 |
| MRA of the neck without contrast | $3,955 | $891 | $343 |
| MRI of the abdomen | $3,137 | $782 | $300 |
| MRI of the abdomen with contrast | $3,137 | $782 | $300 |
| MRI of the abdomen without contrast | $2,555 | $561 | $194 |
| MRI of the ankle | $3,137 | $782 | $261 |
| MRI of the ankle with contrast | $3,137 | $782 | $261 |
| MRI of the ankle without contrast | $2,555 | $721 | $222 |
| MRI of the brain | $3,137 | $653 | $269 |
| MRI of the brain with contrast | $3,137 | $653 | $269 |
| MRI of the brain without contrast | $2,560 | $631 | $195 |
| MRI of the chest | $3,137 | $839 | $371 |
| MRI of the chest with contrast | $3,137 | $782 | $371 |
| MRI of the chest without contrast | $3,955 | $1,087 | $466 |
| MRI of the knee | $3,137 | $963 | $315 |
| MRI of the knee with contrast | $3,137 | $963 | $315 |
| MRI of the knee without contrast | $2,555 | $835 | $204 |
| MRI of the lower back (lumbar spine) | $3,137 | $773 | $270 |
| MRI of the lower back (lumbar spine) with contrast | $3,137 | $770 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $2,555 | $773 | $192 |
| MRI of the mid-back (thoracic spine) | $3,137 | $757 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $3,956 | $926 | $319 |
| MRI of the mid-back (thoracic spine) with contrast | $3,137 | $743 | $271 |
| MRI of the mid-back (thoracic spine) without contrast | $2,555 | $757 | $190 |
| MRI of the neck (cervical spine) | $3,137 | $808 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $3,956 | $895 | $318 |
| MRI of the neck (cervical spine) with contrast | $3,137 | $808 | $274 |
| MRI of the neck (cervical spine) without contrast | $2,555 | $697 | $191 |
| MRI of the pelvis | $3,137 | $782 | $268 |
| MRI of the pelvis with contrast | $3,137 | $782 | $268 |
| MRI of the pelvis without contrast | $2,555 | $780 | $227 |
| MRI of the shoulder | $3,137 | $802 | $313 |
| MRI of the shoulder with contrast | $3,137 | $802 | $313 |
| MRI of the shoulder without contrast | $2,555 | $773 | $205 |
| MRI of the wrist | $3,140 | $782 | $330 |
| MRI of the wrist with contrast | $3,140 | $782 | $330 |
| MRI of the wrist without contrast | $2,555 | $677 | $303 |
| Nuclear cardiac stress test | $2,207 | $1,444 | $428 |
| Occupational therapy evaluation | $484 | $181 | $101 |
| Occupational therapy evaluation (high complexity) | $534 | $181 | $101 |
| Occupational therapy evaluation (low complexity) | $437 | $181 | $101 |
| Occupational therapy evaluation (moderate complexity) | $484 | $181 | $101 |
| Pap smear (cervical screening) | $200 | $52 | $20 |
| Parathyroid hormone (PTH) test | $446 | $98 | $41 |
| Pelvic ultrasound | $465 | $269 | $78 |
| Pelvic ultrasound (complete) | $630 | $342 | $105 |
| Pelvic ultrasound (limited) | $465 | $196 | $51 |
| Phosphorus blood test | $54 | $17 | $5 |
| Physical therapy evaluation | $480 | $152 | $98 |
| Physical therapy evaluation (high complexity) | $529 | $152 | $98 |
| Physical therapy evaluation (moderate complexity) | $480 | $152 | $98 |
| Platelet count | $53 | $22 | $4 |
| Pregnancy blood test (hCG) | $70 | $34 | $8 |
| Pregnancy ultrasound | $596 | $303 | $126 |
| Pregnancy ultrasound (first trimester) | $596 | $280 | $117 |
| Pregnancy ultrasound (second or third trimester) | $708 | $325 | $136 |
| Prolactin test | $210 | $70 | $19 |
| Prostate test (PSA) | $200 | $67 | $18 |
| Psychiatric evaluation | $341 | $159 | $188 |
| Scoliosis spine X-ray | $305 | $166 | $58 |
| Scoliosis spine X-ray (1 view) | $305 | $125 | $44 |
| Scoliosis spine X-ray (3 views) | $504 | $207 | $72 |
| Screening mammogram | $399 | $193 | $126 |
| Scrotal ultrasound | $635 | $301 | $99 |
| Sedimentation rate (ESR) test | $42 | $29 | $3 |
| Semen analysis | $133 | $28 | $12 |
| Sex hormone binding globulin test | $172 | $40 | $22 |
| Simple laceration repair (small, up to 2.5 cm) | $293 | $125 | $114 |
| Simple wound stitches | $293 | $135 | $127 |
| Soft tissue ultrasound | $151 | $155 | $64 |
| Speech therapy | $334 | $132 | $76 |
| Spirometry (lung function test) | $227 | $122 | $30 |
| Spirometry with bronchodilator | $468 | $167 | $43 |
| Strep throat test | $105 | $36 | $17 |
| Swallow study | $480 | $179 | $85 |
| T3 thyroid test | $155 | $56 | $14 |
| Testosterone test | $240 | $100 | $26 |
| Thyroid test (TSH) | $183 | $76 | $17 |
| Thyroid ultrasound | $604 | $310 | $109 |
| Thyroid uptake scan | $1,096 | $274 | $145 |
| Total protein test | $44 | $27 | $4 |
| Transvaginal ultrasound | $626 | $208 | $118 |
| Triglycerides test | $66 | $44 | $6 |
| Troponin (heart) test | $109 | $71 | $12 |
| Upper GI series (barium) | $855 | $368 | $128 |
| Uric acid (gout) test | $53 | $23 | $5 |
| Urinalysis | $24 | $20 | $3 |
| Urine microalbumin test | $56 | $38 | $5 |
| Urine pregnancy test | $60 | $27 | $9 |
| Vaccine administration | $28 | $7 | $19 |
| Vitamin B12 test | $164 | $78 | $15 |
| Vitamin D test | $320 | $40 | $30 |
| X-ray of the abdomen | $318 | $223 | $36 |
| X-ray of the ankle | $263 | $140 | $37 |
| X-ray of the collarbone | $229 | $121 | $33 |
| X-ray of the elbow | $307 | $154 | $33 |
| X-ray of the facial bones | $309 | $138 | $39 |
| X-ray of the foot | $260 | $142 | $34 |
| X-ray of the forearm | $229 | $127 | $29 |
| X-ray of the hand | $263 | $148 | $38 |
| X-ray of the hip | $305 | $126 | $49 |
| X-ray of the hip (1 view) | $305 | $126 | $34 |
| X-ray of the hip (3 views) | $305 | $125 | $49 |
| X-ray of the knee | $236 | $163 | $42 |
| X-ray of the knee (2 views) | $236 | $63 | $34 |
| X-ray of the knee (3 views) | $295 | $163 | $42 |
| X-ray of the knee (4+ views) | $338 | $182 | $49 |
| X-ray of the lower back (lumbar spine) | $330 | $230 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $330 | $204 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $461 | $255 | $53 |
| X-ray of the lower leg | $221 | $143 | $31 |
| X-ray of the mid-back (thoracic spine) | $274 | $172 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $274 | $176 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $330 | $168 | $39 |
| X-ray of the neck (cervical spine) | $307 | $199 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $307 | $169 | $40 |
| X-ray of the pelvis | $209 | $194 | $36 |
| X-ray of the pelvis (1 view) | $209 | $210 | $28 |
| X-ray of the ribs | $313 | $199 | $42 |
| X-ray of the ribs (2 views) | $260 | $154 | $36 |
| X-ray of the ribs (3 views) | $313 | $224 | $42 |
| X-ray of the shoulder | $248 | $155 | $36 |
| X-ray of the skull | $293 | $183 | $40 |
| X-ray of the upper arm | $248 | $149 | $32 |
| X-ray of the wrist | $301 | $141 | $43 |
| Zinc blood test | $81 | $32 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
