| Procedure | New London Hospital | Mt Ascutney Hospital | Medicare |
|---|
| 3D mammogram (tomosynthesis) | $112 | $146 | $51 |
| Abdominal fluid drain (paracentesis) | $574 | $1,959 | $284 |
| Abdominal ultrasound | $328 | $854 | $100 |
| Abdominal ultrasound (complete) | $424 | $1,104 | $114 |
| Abdominal ultrasound (limited) | $214 | $854 | $86 |
| Albumin blood test | $27 | $71 | $5 |
| Aldosterone test | $43 | $699 | $41 |
| Alkaline phosphatase test | $13 | $90 | $5 |
| Alpha-fetoprotein (AFP) test | $52 | $244 | $17 |
| ALT liver enzyme test | $26 | $79 | $5 |
| Ammonia blood test | $66 | $250 | $15 |
| Amylase test | $25 | $97 | $6 |
| Antinuclear antibody (ANA) test | $50 | $209 | $12 |
| Arterial blood gas (ABG) | $71 | $526 | $26 |
| AST liver enzyme test | $21 | $90 | $5 |
| Barium swallow study | $396 | $1,606 | $107 |
| Basic metabolic panel | $37 | $145 | $8 |
| Bilirubin blood test | $25 | $87 | $5 |
| Bladder scope (cystoscopy) | $368 | $1,194 | $216 |
| Blood clotting test (PT/INR) | $21 | $59 | $4 |
| Blood crossmatch | $157 | $195 | — |
| Blood glucose test | $19 | $62 | $5 |
| Blood transfusion | $425 | $631 | $47 |
| Blood type and screen | $60 | $182 | $10 |
| Blood type test | $19 | $52 | $3 |
| Blood type test (ABO group) | $32 | $52 | $3 |
| Blood type test (Rh/D antigen) | $15 | $52 | $3 |
| BNP (heart failure) test | $107 | $582 | $39 |
| Bone density scan (DEXA) | $252 | $793 | $39 |
| Breast biopsy | $1,276 | $2,902 | $478 |
| Breast ultrasound | $308 | $1,648 | $92 |
| Breast ultrasound (complete) | $333 | $1,648 | $100 |
| Breast ultrasound (limited) | $226 | $414 | $84 |
| Breathing tube insertion (intubation) | $278 | $587 | $133 |
| C-reactive protein (CRP) | $50 | $59 | $5 |
| CA 19-9 tumor marker test | $85 | $356 | $21 |
| CA-125 ovarian marker test | $85 | $356 | $21 |
| Calcium blood test | $21 | $70 | $5 |
| Carotid artery ultrasound | $770 | $844 | $156 |
| CEA tumor marker test | $71 | $250 | $19 |
| Celiac disease test | $11 | $196 | $12 |
| Chemotherapy infusion | $204 | $164 | $81 |
| Chemotherapy infusion (each additional) | $99 | $129 | $28 |
| Chemotherapy infusion (first hour) | $310 | $199 | $133 |
| Chest fluid drain (thoracentesis) | $820 | $1,905 | $311 |
| Chest tube insertion | $467 | $1,444 | $143 |
| Chest X-ray | $150 | $598 | $37 |
| Chest X-ray (1 view) | $122 | $352 | $25 |
| Chest X-ray (2 views) | $146 | $453 | $33 |
| Clotting time test (PTT) | $29 | $102 | $6 |
| Colonoscopy | $1,595 | $1,210 | $480 |
| Complete blood count (CBC) | $35 | $108 | $7 |
| Complete blood count (CBC) (complete) | $43 | $118 | $8 |
| Comprehensive metabolic panel | $46 | $170 | $11 |
| Copper blood test | $39 | $212 | $12 |
| Cortisol test | $32 | $286 | $16 |
| COVID-19 PCR test | $228 | $125 | $51 |
| CPAP titration study | $137 | $562 | $69 |
| Creatine kinase (CK) test | $32 | $112 | $7 |
| CT angiography of the chest | $1,360 | $6,647 | $281 |
| CT angiography of the head | $1,275 | $5,498 | $274 |
| CT scan of the abdomen | $1,134 | $3,943 | $230 |
| CT scan of the abdomen and pelvis | $1,919 | $4,038 | $300 |
| CT scan of the abdomen and pelvis with and without contrast | $2,111 | $4,744 | $338 |
| CT scan of the abdomen and pelvis with contrast | $1,919 | $3,935 | $300 |
| CT scan of the abdomen and pelvis without contrast | $1,248 | $1,911 | $183 |
| CT scan of the abdomen with and without contrast | $1,406 | $5,413 | $259 |
| CT scan of the abdomen with contrast | $1,134 | $3,445 | $230 |
| CT scan of the abdomen without contrast | $783 | $2,749 | $136 |
| CT scan of the arm | $918 | $3,521 | $199 |
| CT scan of the arm with contrast | $918 | $3,521 | $199 |
| CT scan of the arm without contrast | $623 | $2,835 | $161 |
| CT scan of the chest | $1,093 | $3,157 | $167 |
| CT scan of the chest with and without contrast | $1,266 | $4,567 | $196 |
| CT scan of the chest with contrast | $1,093 | $3,630 | $167 |
| CT scan of the chest without contrast | $646 | $2,709 | $133 |
| CT scan of the head | $914 | $2,769 | $148 |
| CT scan of the head with and without contrast | $1,145 | $3,271 | $173 |
| CT scan of the head with contrast | $873 | $2,769 | $148 |
| CT scan of the head without contrast | $914 | $2,111 | $107 |
| CT scan of the leg | $938 | $3,562 | $166 |
| CT scan of the leg with contrast | $938 | $3,562 | $166 |
| CT scan of the leg without contrast | $646 | $2,758 | $130 |
| CT scan of the lower back (lumbar spine) | $934 | $3,222 | $169 |
| CT scan of the lower back (lumbar spine) with and without contrast | $1,152 | $3,981 | $197 |
| CT scan of the lower back (lumbar spine) with contrast | $934 | $3,233 | $169 |
| CT scan of the lower back (lumbar spine) without contrast | $786 | $2,981 | $130 |
| CT scan of the neck | $873 | $3,360 | $183 |
| CT scan of the neck (cervical spine) | $936 | $2,935 | $168 |
| CT scan of the neck (cervical spine) with and without contrast | $1,154 | $3,398 | $196 |
| CT scan of the neck (cervical spine) with contrast | $936 | $3,235 | $168 |
| CT scan of the neck (cervical spine) without contrast | $786 | $2,628 | $131 |
| CT scan of the neck with and without contrast | $1,145 | $4,081 | $220 |
| CT scan of the neck with contrast | $873 | $3,360 | $183 |
| CT scan of the neck without contrast | $804 | $2,895 | $150 |
| CT scan of the pelvis | $1,134 | $3,446 | $226 |
| CT scan of the pelvis with and without contrast | $1,287 | $4,610 | $251 |
| CT scan of the pelvis with contrast | $1,134 | $3,446 | $226 |
| CT scan of the pelvis without contrast | $895 | $2,757 | $133 |
| CT scan of the sinuses | $873 | $3,406 | $152 |
| CT scan of the sinuses with and without contrast | $1,145 | $4,570 | $184 |
| CT scan of the sinuses with contrast | $873 | $3,662 | $152 |
| CT scan of the sinuses without contrast | $804 | $2,997 | $128 |
| D-dimer test | $59 | $174 | $10 |
| DHEA-sulfate test | $69 | $312 | $22 |
| Diagnostic mammogram | $500 | $619 | $140 |
| Drug screen (urine) | $92 | $39 | $17 |
| Ear tubes (myringotomy) | $371 | $2,419 | $174 |
| Echocardiogram | $425 | $1,785 | $138 |
| EKG / ECG (tracing only) | $75 | $335 | $7 |
| Electrocardiogram (EKG) | $56 | $339 | $8 |
| Electrolyte panel | $38 | $120 | $7 |
| Electromyography (EMG) | $316 | $765 | $141 |
| Emergency department visit | $191 | $491 | $69 |
| Emergency department visit (level 1) | $88 | $297 | $11 |
| Emergency department visit (level 2) | $131 | $332 | $40 |
| Emergency department visit (level 3) | $223 | $491 | $69 |
| Emergency department visit (level 4) | $335 | $785 | $118 |
| Emergency department visit (level 5) | $486 | $1,259 | $171 |
| Epidural steroid injection | $536 | $2,250 | $275 |
| Estradiol (estrogen) test | $31 | $472 | $28 |
| Facet joint injection (spine) | $370 | $1,778 | $99 |
| Fallopian tube X-ray (HSG) | $371 | $1,444 | $164 |
| Fecal occult blood (stool) test | $68 | $38 | $10 |
| Fecal occult blood (stool) test (immunochemical, FIT) | $68 | $182 | $16 |
| Ferritin (iron) test | $94 | $218 | $14 |
| Fibrinogen test | $34 | $145 | $10 |
| Flexible sigmoidoscopy | $428 | $786 | $323 |
| Flu test | $15 | $85 | $17 |
| Folate (folic acid) test | $60 | $233 | $15 |
| Foreign body removal (skin) | $162 | $685 | $157 |
| Free T4 thyroid test | $59 | $157 | $9 |
| FSH hormone test | $48 | $321 | $19 |
| Gallbladder removal (laparoscopic) | $1,145 | $3,628 | $658 |
| GGT liver test | $30 | $81 | $7 |
| Glucose tolerance test | $36 | $174 | $8 |
| Hematocrit test | $11 | $42 | $2 |
| Hemoglobin A1c (diabetes test) | $40 | $166 | $10 |
| Hemorrhoid removal | $688 | $2,786 | $338 |
| Hepatitis A vaccine | $173 | $68 | — |
| Hepatitis B test | $46 | $178 | $10 |
| Hepatitis B vaccine | $137 | $55 | — |
| Hepatitis C test | $60 | $183 | $14 |
| HIV test | $67 | $182 | $19 |
| Holter heart monitor | $289 | $227 | $26 |
| Inguinal hernia repair | $1,277 | $2,532 | $538 |
| Iron blood test | $40 | $112 | $6 |
| IV infusion therapy | $150 | $143 | $44 |
| IV infusion therapy (each additional) | $72 | $104 | $21 |
| IV infusion therapy (initial) | $228 | $143 | $67 |
| Joint aspiration (small/intermediate) | $77 | $586 | $57 |
| Joint aspiration or injection (mid-size joint) | $64 | $581 | $57 |
| Joint aspiration or injection (small joint) | $152 | $591 | $56 |
| Kidney ultrasound | $139 | $985 | $84 |
| Kidney ultrasound (limited) | $120 | $906 | $61 |
| Knee arthroscopy | $1,228 | $1,701 | $524 |
| Knee joint injection | $194 | $254 | $69 |
| Lactate test | $46 | $184 | $12 |
| LDH test | $30 | $103 | $6 |
| LDL cholesterol test | $37 | $137 | $11 |
| Leg vein ultrasound (Doppler) | $485 | $678 | $150 |
| Leg vein ultrasound (Doppler) (limited) | $345 | $678 | $116 |
| LH hormone test | $54 | $304 | $19 |
| Lipase test | $34 | $79 | $7 |
| Lipid (cholesterol) panel | $59 | $160 | $13 |
| Liver biopsy | $616 | $1,485 | $288 |
| Liver function panel | $36 | $136 | $8 |
| Lung function test (PFT) | $202 | $318 | $37 |
| Magnesium blood test | $40 | $112 | $7 |
| MMR vaccine | $220 | $90 | — |
| MRA of the brain | $1,504 | $6,710 | $226 |
| MRA of the brain without contrast | $1,966 | $8,504 | $328 |
| MRA of the neck | $1,504 | $6,245 | $245 |
| MRA of the neck with contrast | $1,504 | $4,543 | $245 |
| MRA of the neck without contrast | $1,966 | $8,510 | $343 |
| MRI of the abdomen | $1,769 | $6,551 | $300 |
| MRI of the abdomen without contrast | $1,295 | $4,369 | $194 |
| MRI of the ankle | $1,644 | $6,140 | $261 |
| MRI of the ankle without contrast | $1,259 | $5,654 | $222 |
| MRI of the brain | $1,768 | $5,888 | $269 |
| MRI of the brain with contrast | $1,768 | $5,426 | $269 |
| MRI of the brain without contrast | $1,185 | $5,704 | $195 |
| MRI of the chest | $1,804 | $6,562 | $371 |
| MRI of the chest without contrast | $2,359 | $8,062 | $466 |
| MRI of the knee | $1,676 | $5,893 | $315 |
| MRI of the knee with contrast | $1,676 | $5,893 | $315 |
| MRI of the knee without contrast | $1,259 | $5,509 | $204 |
| MRI of the lower back (lumbar spine) | $1,515 | $5,050 | $270 |
| MRI of the lower back (lumbar spine) with contrast | $1,515 | $4,389 | $270 |
| MRI of the lower back (lumbar spine) without contrast | $1,382 | $4,428 | $192 |
| MRI of the mid-back (thoracic spine) | $1,515 | $5,299 | $271 |
| MRI of the mid-back (thoracic spine) with and without contrast | $1,969 | $6,505 | $319 |
| MRI of the mid-back (thoracic spine) with contrast | $1,515 | $5,058 | $271 |
| MRI of the mid-back (thoracic spine) without contrast | $1,382 | $4,433 | $190 |
| MRI of the neck (cervical spine) | $1,515 | $5,430 | $274 |
| MRI of the neck (cervical spine) with and without contrast | $1,969 | $6,781 | $318 |
| MRI of the neck (cervical spine) with contrast | $1,515 | $5,428 | $274 |
| MRI of the neck (cervical spine) without contrast | $1,382 | $4,388 | $191 |
| MRI of the pelvis | $1,721 | $5,783 | $268 |
| MRI of the pelvis without contrast | $1,249 | $4,899 | $227 |
| MRI of the shoulder | $1,969 | $5,789 | $313 |
| MRI of the shoulder with contrast | $1,969 | $5,789 | $313 |
| MRI of the shoulder without contrast | $1,251 | $5,389 | $205 |
| MRI of the wrist | $1,722 | $6,159 | $330 |
| MRI of the wrist without contrast | $1,251 | $5,789 | $303 |
| Nebulizer breathing treatment | $81 | $179 | $9 |
| Nerve conduction study | $271 | $482 | $118 |
| Occupational therapy evaluation | $179 | $419 | $101 |
| Occupational therapy evaluation (high complexity) | $192 | $506 | $101 |
| Occupational therapy evaluation (low complexity) | $154 | $346 | $101 |
| Occupational therapy evaluation (moderate complexity) | $179 | $419 | $101 |
| Office visit (new patient) | $163 | $359 | $177 |
| Office visit, new patient (level 3) | $126 | $234 | $118 |
| Office visit, new patient (level 4) | $163 | $359 | $177 |
| Office visit, new patient (level 5) | $207 | $443 | $237 |
| Pap smear (cervical screening) | $112 | $263 | $20 |
| Parathyroid hormone (PTH) test | $97 | $580 | $41 |
| Pelvic ultrasound | $195 | $995 | $78 |
| Pelvic ultrasound (complete) | $399 | $995 | $105 |
| Pelvic ultrasound (limited) | $147 | $1,955 | $51 |
| Phosphorus blood test | $46 | $80 | $5 |
| Physical therapy evaluation | $166 | $419 | $98 |
| Physical therapy evaluation (high complexity) | $179 | $506 | $98 |
| Physical therapy evaluation (moderate complexity) | $166 | $419 | $98 |
| Platelet count | $19 | $77 | $4 |
| Pregnancy ultrasound | $390 | $1,945 | $126 |
| Pregnancy ultrasound (first trimester) | $346 | $1,945 | $117 |
| Pregnancy ultrasound (second or third trimester) | $434 | $1,223 | $136 |
| Prolactin test | $59 | $309 | $19 |
| Prostate test (PSA) | $92 | $260 | $18 |
| Psychotherapy session | $108 | $304 | $140 |
| Radiofrequency nerve ablation | $862 | $2,939 | $462 |
| Sacroiliac joint injection | $413 | $2,238 | $176 |
| Scoliosis spine X-ray | $201 | $1,236 | $58 |
| Scoliosis spine X-ray (1 view) | $144 | $611 | $44 |
| Scoliosis spine X-ray (3 views) | $259 | $1,236 | $72 |
| Screening mammogram | $464 | $619 | $126 |
| Scrotal ultrasound | $205 | $1,006 | $99 |
| Sedimentation rate (ESR) test | $29 | $60 | $3 |
| Semen analysis | $41 | $209 | $12 |
| Soft tissue ultrasound | $109 | $491 | $64 |
| Speech therapy | $96 | $350 | $76 |
| Spirometry (lung function test) | $151 | $303 | $30 |
| Spirometry with bronchodilator | $278 | $367 | $43 |
| Strep throat test | $47 | $71 | $17 |
| Swallow study | $205 | $298 | $85 |
| T3 thyroid test | $58 | $253 | $14 |
| Tdap (tetanus) vaccine | $111 | $40 | — |
| Testosterone test | $39 | $324 | $26 |
| Thyroid test (TSH) | $36 | $235 | $17 |
| Thyroid ultrasound | $271 | $995 | $109 |
| Tonsillectomy | $900 | $1,290 | $252 |
| Total IgE allergy test | $60 | $243 | $16 |
| Total protein test | $18 | $64 | $4 |
| Transvaginal ultrasound | $275 | $999 | $118 |
| Trigger point injection | $72 | $745 | $56 |
| Trigger point injection (1-2 muscles) | $68 | $900 | $52 |
| Triglycerides test | $25 | $87 | $6 |
| Troponin (heart) test | $133 | $170 | $12 |
| Upper GI endoscopy (EGD) | $1,079 | $737 | $371 |
| Upper GI series (barium) | $420 | $2,121 | $128 |
| Uric acid (gout) test | $22 | $78 | $5 |
| Urinalysis | $16 | $48 | $3 |
| Urine microalbumin test | $34 | $86 | $5 |
| Urine pregnancy test | $26 | $72 | $9 |
| Vaccine administration | $38 | $38 | $19 |
| Vaccine administration (each additional) | $24 | $38 | $16 |
| Vasectomy | $505 | $1,298 | $347 |
| Vitamin B12 test | $75 | $179 | $15 |
| Vitamin D test | $120 | $281 | $30 |
| X-ray of the abdomen | $148 | $645 | $36 |
| X-ray of the ankle | $161 | $572 | $37 |
| X-ray of the collarbone | $114 | $491 | $33 |
| X-ray of the elbow | $126 | $611 | $33 |
| X-ray of the facial bones | $140 | $603 | $39 |
| X-ray of the foot | $152 | $555 | $34 |
| X-ray of the forearm | $100 | $474 | $29 |
| X-ray of the hand | $134 | $564 | $38 |
| X-ray of the hip | $142 | $842 | $49 |
| X-ray of the hip (1 view) | $113 | $391 | $34 |
| X-ray of the hip (3 views) | $171 | $1,017 | $49 |
| X-ray of the knee | $148 | $634 | $42 |
| X-ray of the knee (2 views) | $126 | $507 | $34 |
| X-ray of the knee (3 views) | $148 | $634 | $42 |
| X-ray of the knee (4+ views) | $201 | $726 | $49 |
| X-ray of the lower back (lumbar spine) | $160 | $822 | $47 |
| X-ray of the lower back (lumbar spine) (2 views) | $135 | $693 | $40 |
| X-ray of the lower back (lumbar spine) (4+ views) | $185 | $950 | $53 |
| X-ray of the lower leg | $113 | $459 | $31 |
| X-ray of the mid-back (thoracic spine) | $131 | $547 | $36 |
| X-ray of the mid-back (thoracic spine) (2 views) | $128 | $513 | $33 |
| X-ray of the mid-back (thoracic spine) (3 views) | $134 | $547 | $39 |
| X-ray of the neck (cervical spine) | $196 | $770 | $47 |
| X-ray of the neck (cervical spine) (3 views) | $134 | $653 | $40 |
| X-ray of the pelvis | $140 | $579 | $36 |
| X-ray of the pelvis (1 view) | $129 | $413 | $28 |
| X-ray of the ribs | $137 | $629 | $42 |
| X-ray of the ribs (2 views) | $123 | $517 | $36 |
| X-ray of the ribs (3 views) | $137 | $629 | $42 |
| X-ray of the shoulder | $179 | $496 | $36 |
| X-ray of the skull | $144 | $733 | $40 |
| X-ray of the upper arm | $115 | $491 | $32 |
| X-ray of the wrist | $152 | $661 | $43 |
| Zinc blood test | $29 | $196 | $11 |
Green = lower cash price. Source: hospitals' machine-readable files (45 CFR §180). Estimates — confirm with the hospital.
