| Procedure | Mainehealth Stephens Hospital | Androscoggin Valley Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $262 | $49 | $51 |
| Abdominal fluid drain (paracentesis) | $1,348 | $825 | $284 |
| Abdominal ultrasound | $894 | $554 | $100 |
| Abdominal ultrasound (complete) | $1,040 | $631 | $114 |
| Abdominal ultrasound (limited) | $747 | $478 | $86 |
| Abscess drainage (complex or multiple) | $243 | $294 | $220 |
| Abscess drainage (simple) | $243 | $191 | $129 |
| Abscess incision and drainage | $243 | $224 | $174 |
| Albumin blood test | $64 | $44 | $5 |
| Aldosterone test | $449 | $257 | $41 |
| Alkaline phosphatase test | $73 | $33 | $5 |
| Alpha-fetoprotein (AFP) test | $195 | $60 | $17 |
| ALT liver enzyme test | $68 | $20 | $5 |
| Ammonia blood test | $183 | $53 | $15 |
| Amylase test | $81 | $24 | $6 |
| Antinuclear antibody (ANA) test | $153 | $44 | $12 |
| AST liver enzyme test | $65 | $19 | $5 |
| Barium swallow study | $657 | $513 | $107 |
| Basic metabolic panel | $106 | $54 | $8 |
| Bilirubin blood test | $64 | $19 | $5 |
| Blood clotting test (PT/INR) | $50 | $40 | $4 |
| Blood crossmatch | $177 | $164 | — |
| Blood glucose test | $49 | $16 | $5 |
| Blood transfusion | $1,264 | $868 | $47 |
| Blood type and screen | $101 | $124 | $10 |
| Blood type test | $39 | $11 | $3 |
| Blood type test (ABO group) | $39 | $11 | $3 |
| Blood type test (Rh/D antigen) | $39 | $11 | $3 |
| BNP (heart failure) test | $428 | $142 | $39 |
| Bone density scan (DEXA) | $1,001 | $471 | $39 |
| Bone scan (nuclear) | $2,800 | $1,328 | $259 |
| Breast biopsy | $2,349 | $1,453 | $478 |
| Breast ultrasound | $520 | $389 | $92 |
| Breast ultrasound (limited) | $485 | $389 | $84 |
| Breathing tube insertion (intubation) | $356 | $230 | $133 |
| Burn dressing and debridement (small) | $181 | $156 | $93 |
| Burn treatment | $181 | $156 | $129 |
| C-reactive protein (CRP) | $65 | $64 | $5 |
| CA 19-9 tumor marker test | $262 | $132 | $21 |
| CA-125 ovarian marker test | $262 | $132 | $21 |
| Calcium blood test | $65 | $19 | $5 |
| Cardiac rehabilitation | $287 | $188 | $26 |
| Cardiac stress test | $1,044 | $836 | $39 |
| Cardioversion | $727 | $482 | $155 |
| Carotid artery ultrasound | $1,536 | $885 | $156 |
| CEA tumor marker test | $239 | $121 | $19 |
| Celiac disease test | $93 | $42 | $12 |
| Central line placement | $1,291 | $1,033 | $238 |
| Chemotherapy infusion | $382 | $393 | $81 |
| Chemotherapy infusion (each additional) | $188 | $154 | $28 |
| Chemotherapy infusion (first hour) | $576 | $632 | $133 |
| Chest X-ray | $362 | $206 | $37 |
| Chest X-ray (1 view) | $246 | $175 | $25 |
| Chest X-ray (2 views) | $331 | $238 | $33 |
| Circumcision | $247 | $999 | $167 |
| CK-MB heart enzyme test | $98 | $67 | $12 |
| Clotting time test (PTT) | $76 | $23 | $6 |
| Complete blood count (CBC) | $88 | $45 | $7 |
| Complete blood count (CBC) (complete) | $96 | $44 | $8 |
| Comprehensive metabolic panel | $135 | $96 | $11 |
| Copper blood test | $137 | $46 | $12 |
| Cortisol test | $197 | $103 | $16 |
| COVID-19 PCR test | $83 | $73 | $51 |
| CPAP titration study | $298 | $441 | $69 |
| Creatine kinase (CK) test | $82 | $42 | $7 |
| CT angiography of the chest | $4,260 | $2,374 | $281 |
| CT angiography of the head | $3,727 | $2,191 | $274 |
| CT scan of the abdomen | $2,401 | $1,666 | $230 |
| CT scan of the abdomen and pelvis | $2,277 | $2,989 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $2,925 | $3,183 | $338 |
| CT scan of the abdomen and pelvis with contrast | $2,277 | $2,989 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,209 | $2,795 | $183 |
| CT scan of the abdomen with and without contrast | $2,974 | $1,911 | $259 |
| CT scan of the abdomen with contrast | $2,401 | $1,666 | $230 |
| CT scan of the abdomen without contrast | $1,987 | $1,472 | $136 |
| CT scan of the arm | $2,716 | $1,569 | $199 |
| CT scan of the arm with contrast | $2,716 | $1,666 | $199 |
| CT scan of the arm without contrast | $2,600 | $1,472 | $161 |
| CT scan of the chest | $2,482 | $1,569 | $167 |
| CT scan of the chest with contrast | $2,482 | $1,666 | $167 |
| CT scan of the chest without contrast | $2,108 | $1,472 | $133 |
| CT scan of the head | $1,987 | $1,666 | $148 |
| CT scan of the head with and without contrast | $2,482 | $1,860 | $173 |
| CT scan of the head with contrast | $1,987 | $1,666 | $148 |
| CT scan of the head without contrast | $1,728 | $1,472 | $107 |
| CT scan of the leg | $2,716 | $1,569 | $166 |
| CT scan of the leg with contrast | $2,716 | $1,666 | $166 |
| CT scan of the leg without contrast | $2,600 | $1,472 | $130 |
| CT scan of the lower back (lumbar spine) | $2,482 | $1,472 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $2,108 | $1,472 | $130 |
| CT scan of the neck | $1,987 | $1,569 | $183 |
| CT scan of the neck (cervical spine) | $2,108 | $1,516 | $168 |
| CT scan of the neck (cervical spine) without contrast | $2,108 | $1,472 | $131 |
| CT scan of the neck with contrast | $1,987 | $1,666 | $183 |
| CT scan of the neck without contrast | $1,728 | $1,472 | $150 |
| CT scan of the pelvis | $2,401 | $1,666 | $226 |
| CT scan of the pelvis with and without contrast | $2,974 | $1,860 | $251 |
| CT scan of the pelvis with contrast | $2,401 | $1,666 | $226 |
| CT scan of the pelvis without contrast | $2,108 | $1,472 | $133 |
| CT scan of the sinuses | $1,987 | $1,569 | $152 |
| CT scan of the sinuses with contrast | $1,987 | $1,666 | $152 |
| CT scan of the sinuses without contrast | $1,728 | $1,472 | $128 |
| D-dimer test | $131 | $38 | $10 |
| DHEA-sulfate test | $246 | $81 | $22 |
| Diagnostic mammogram | $938 | $650 | $140 |
| Drug screen (urine) | $183 | $121 | $17 |
| Echocardiogram | $1,195 | $1,729 | $138 |
| EKG / ECG (tracing only) | $331 | $207 | $7 |
| Electrocardiogram (EKG) | $331 | $110 | $8 |
| Electrolyte panel | $89 | $53 | $7 |
| Emergency department visit | $276 | $272 | $69 |
| Emergency department visit (level 1) | $196 | $157 | $11 |
| Emergency department visit (level 2) | $262 | $174 | $40 |
| Emergency department visit (level 3) | $523 | $305 | $69 |
| Emergency department visit (level 4) | $949 | $487 | $118 |
| Emergency department visit (level 5) | $1,570 | $701 | $171 |
| Epidural steroid injection | $515 | $926 | $275 |
| Estradiol (estrogen) test | $347 | $101 | $28 |
| Fecal occult blood (stool) test | $150 | $58 | $10 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $150 | $101 | $16 |
| Ferritin (iron) test | $171 | $114 | $14 |
| Fibrinogen test | $106 | $36 | $10 |
| Flu test | $131 | $81 | $17 |
| Folate (folic acid) test | $186 | $54 | $15 |
| Foreign body removal (skin) | $323 | $307 | $157 |
| Free T4 thyroid test | $115 | $101 | $9 |
| FSH hormone test | $230 | $118 | $19 |
| Gallbladder scan (HIDA) | $2,879 | $1,807 | $334 |
| GGT liver test | $90 | $47 | $7 |
| Glucose tolerance test | $105 | $31 | $8 |
| HDL cholesterol test | $98 | $30 | $8 |
| Hematocrit test | $33 | $9 | $2 |
| Hemoglobin A1c (diabetes test) | $116 | $62 | $10 |
| Hepatitis B test | $132 | $38 | $10 |
| Hepatitis C test | $165 | $52 | $14 |
| HIV test | $186 | $97 | $19 |
| HIV test (antibody) | $130 | $50 | $14 |
| HIV test (antigen/antibody combo) | $242 | $144 | $24 |
| Iron blood test | $81 | $42 | $6 |
| IUD removal | $870 | $575 | $112 |
| IV infusion therapy | $198 | $238 | $44 |
| IV infusion therapy (each additional) | $98 | $129 | $21 |
| IV infusion therapy (initial) | $298 | $348 | $67 |
| Joint aspiration (small/intermediate) | $323 | $121 | $57 |
| Joint aspiration or injection (mid-size joint) | $323 | $174 | $57 |
| Joint aspiration or injection (small joint) | $440 | $67 | $56 |
| Kidney scan (nuclear) | $2,932 | $1,319 | $172 |
| Kidney ultrasound | $781 | $490 | $84 |
| Kidney ultrasound (limited) | $522 | $463 | $61 |
| Knee joint injection | $323 | $92 | $69 |
| Lactate test | $136 | $42 | $12 |
| LDH test | $77 | $39 | $6 |
| LDL cholesterol test | $126 | $60 | $11 |
| Leg vein ultrasound (Doppler) | $988 | $1,032 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $988 | $931 | $116 |
| LH hormone test | $231 | $67 | $19 |
| Lipase test | $88 | $58 | $7 |
| Lipid (cholesterol) panel | $170 | $137 | $13 |
| Liver function panel | $103 | $61 | $8 |
| Lung function test (PFT) | $203 | $119 | $37 |
| Magnesium blood test | $84 | $54 | $7 |
| MRA of the brain | $3,933 | $2,575 | $226 |
| MRA of the neck | $5,800 | $2,752 | $245 |
| MRA of the neck without contrast | $7,667 | $3,079 | $343 |
| MRI of the abdomen | $4,655 | $3,319 | $300 |
| MRI of the abdomen without contrast | $3,883 | $2,779 | $194 |
| MRI of the ankle | $3,989 | $3,102 | $261 |
| MRI of the ankle without contrast | $3,615 | $2,344 | $222 |
| MRI of the brain | $4,714 | $3,190 | $269 |
| MRI of the brain without contrast | $3,933 | $2,566 | $195 |
| MRI of the knee | $3,946 | $3,114 | $315 |
| MRI of the knee without contrast | $3,615 | $2,316 | $204 |
| MRI of the lower back (lumbar spine) | $4,714 | $3,229 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $4,362 | $2,754 | $192 |
| MRI of the mid-back (thoracic spine) | $4,714 | $3,113 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $8,731 | $3,472 | $319 |
| MRI of the mid-back (thoracic spine) without contrast | $4,362 | $2,754 | $190 |
| MRI of the neck (cervical spine) | $4,714 | $3,113 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $8,731 | $3,472 | $318 |
| MRI of the neck (cervical spine) without contrast | $3,933 | $2,754 | $191 |
| MRI of the pelvis | $4,655 | $3,136 | $268 |
| MRI of the pelvis without contrast | $3,883 | $2,806 | $227 |
| MRI of the shoulder | $3,989 | $2,401 | $313 |
| MRI of the shoulder with contrast | $3,989 | $2,401 | $313 |
| MRI of the shoulder without contrast | $3,615 | $2,207 | $205 |
| MRI of the wrist | $3,989 | $2,207 | $330 |
| MRI of the wrist without contrast | $3,615 | $2,207 | $303 |
| Nebulizer breathing treatment | $117 | $145 | $9 |
| Nuclear cardiac stress test | $2,643 | $3,227 | $428 |
| Occupational therapy evaluation | $343 | $258 | $101 |
| Occupational therapy evaluation (low complexity) | $343 | $243 | $101 |
| Occupational therapy evaluation (moderate complexity) | $343 | $273 | $101 |
| Office visit (established patient) | $73 | $132 | $115 |
| Office visit (new patient) | $151 | $122 | $177 |
| Office visit, established patient (level 3) | $50 | $107 | $95 |
| Office visit, established patient (level 4) | $73 | $158 | $136 |
| Office visit, new patient (level 3) | $79 | $98 | $118 |
| Office visit, new patient (level 4) | $120 | $146 | $177 |
| Pap smear (cervical screening) | $167 | $159 | $20 |
| Parathyroid hormone (PTH) test | $516 | $260 | $41 |
| Pelvic ultrasound | $430 | $435 | $78 |
| Pelvic ultrasound (complete) | $810 | $511 | $105 |
| Pelvic ultrasound (limited) | $51 | $358 | $51 |
| Phosphorus blood test | $369 | $18 | $5 |
| Physical therapy evaluation | $321 | $273 | $98 |
| Physical therapy evaluation (high complexity) | $321 | $309 | $98 |
| Physical therapy evaluation (moderate complexity) | $321 | $273 | $98 |
| Platelet count | $59 | $17 | $4 |
| Pregnancy blood test (hCG) | $96 | $28 | $8 |
| Pregnancy ultrasound | $1,108 | $559 | $126 |
| Pregnancy ultrasound (first trimester) | $1,108 | $497 | $117 |
| Pregnancy ultrasound (second or third trimester) | $611 | $620 | $136 |
| Procalcitonin test | $90 | $99 | $27 |
| Prolactin test | $241 | $70 | $19 |
| Prostate test (PSA) | $182 | $67 | $18 |
| Scoliosis spine X-ray | $247 | $340 | $58 |
| Scoliosis spine X-ray (3 views) | $268 | $340 | $72 |
| Screening mammogram | $1,036 | $607 | $126 |
| Scrotal ultrasound | $822 | $463 | $99 |
| Sedimentation rate (ESR) test | $41 | $11 | $3 |
| Semen analysis | $152 | $44 | $12 |
| Sex hormone binding globulin test | $210 | $79 | $22 |
| Simple laceration repair (small, up to 2.5 cm) | $154 | $348 | $114 |
| Simple wound stitches | $154 | $358 | $127 |
| Sleep study (polysomnography) | $3,137 | $2,435 | $691 |
| Soft tissue ultrasound | $149 | $299 | $64 |
| Speech therapy | $330 | $225 | $76 |
| Spirometry (lung function test) | $203 | $44 | $30 |
| Spirometry with bronchodilator | $323 | $193 | $43 |
| Stress echocardiogram | $1,499 | $1,271 | $209 |
| Swallow study | $758 | $202 | $85 |
| T3 thyroid test | $179 | $52 | $14 |
| Tdap (tetanus) vaccine | $261 | $33 | — |
| Testosterone test | $278 | $94 | $26 |
| Thyroid test (TSH) | $211 | $124 | $17 |
| Thyroid ultrasound | $823 | $540 | $109 |
| Total IgE allergy test | $205 | $60 | $16 |
| Total protein test | $46 | $25 | $4 |
| Transesophageal echocardiogram (TEE) | $1,371 | $1,346 | $239 |
| Transesophageal echocardiogram (TEE) with and without contrast | $1,371 | $1,346 | $239 |
| Transvaginal ultrasound | $916 | $590 | $118 |
| Trigger point injection | $374 | $83 | $56 |
| Triglycerides test | $72 | $21 | $6 |
| Troponin (heart) test | $124 | $121 | $12 |
| Upper GI series (barium) | $820 | $578 | $128 |
| Uric acid (gout) test | $59 | $17 | $5 |
| Urinalysis | $33 | $26 | $3 |
| Urine microalbumin test | $67 | $59 | $5 |
| Urine pregnancy test | $35 | $32 | $9 |
| Vaccine administration | $46 | $35 | $19 |
| Vitamin B12 test | $152 | $90 | $15 |
| Vitamin D test | $296 | $210 | $30 |
| X-ray of the abdomen | $300 | $243 | $36 |
| X-ray of the ankle | $277 | $278 | $37 |
| X-ray of the collarbone | $270 | $254 | $33 |
| X-ray of the elbow | $305 | $278 | $33 |
| X-ray of the facial bones | $372 | $341 | $39 |
| X-ray of the foot | $338 | $315 | $34 |
| X-ray of the forearm | $270 | $245 | $29 |
| X-ray of the hand | $277 | $282 | $38 |
| X-ray of the hip | $305 | $310 | $49 |
| X-ray of the hip (1 view) | $247 | $251 | $34 |
| X-ray of the hip (3 views) | $305 | $368 | $49 |
| X-ray of the knee | $305 | $347 | $42 |
| X-ray of the knee (2 views) | $270 | $278 | $34 |
| X-ray of the knee (3 views) | $305 | $389 | $42 |
| X-ray of the knee (4+ views) | $331 | $347 | $49 |
| X-ray of the lower back (lumbar spine) | $421 | $347 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $356 | $290 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $485 | $403 | $53 |
| X-ray of the lower leg | $268 | $248 | $31 |
| X-ray of the mid-back (thoracic spine) | $370 | $284 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $347 | $278 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $392 | $290 | $39 |
| X-ray of the neck (cervical spine) | $399 | $314 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $322 | $268 | $40 |
| X-ray of the pelvis | $313 | $305 | $36 |
| X-ray of the pelvis (1 view) | $270 | $282 | $28 |
| X-ray of the ribs | $356 | $268 | $42 |
| X-ray of the ribs (2 views) | $305 | $268 | $36 |
| X-ray of the shoulder | $305 | $260 | $36 |
| X-ray of the skull | $404 | $290 | $40 |
| X-ray of the upper arm | $305 | $251 | $32 |
| X-ray of the wrist | $313 | $251 | $43 |
| Zinc blood test | $115 | $42 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
