Southwestern Vermont Medical Center
Southwestern Vermont Medical Center in Bennington, VT publishes cash prices for 71 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
100 Hospital Dr, Bennington, VT 05201 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 APPENDIX PROTOCOL ABD/PEL W/CO | $3,387.48 | $4,839.25 | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 ABDOMEN PELVIS W/ IV CONTRAST | $3,387.48 | $4,839.25 | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 DIVERTICULITIS CT PROTOCOL | $3,387.48 | $4,839.25 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 ABDOMEN PELVIS W/ IV CONTRAST | $3,387.48 | $4,839.25 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 DIVERTICULITIS CT PROTOCOL | $3,387.48 | $4,839.25 | 30% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 APPENDIX PROTOCOL ABD/PEL W/CO | $3,387.48 | $4,839.25 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 HEAD CT W/O CONTRAST CRITICAL | $1,776.43 | $2,537.75 | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CAT SCAN HEAD W/O CONTRAST LCD | $1,776.43 | $2,537.75 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CAT SCAN HEAD W/O CONTRAST LCD | $1,776.43 | $2,537.75 | 30% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HEAD CT W/O CONTRAST CRITICAL | $1,776.43 | $2,537.75 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 PELVIS W/CONTRAST | $2,337.48 | $3,339.25 | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 APPENDIX PROTOCOL PELVIS W/CON | $2,337.48 | $3,339.25 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 APPENDIX PROTOCOL PELVIS W/CON | $2,337.48 | $3,339.25 | 30% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 PELVIS W/CONTRAST | $2,337.48 | $3,339.25 | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX BILAT MAMM0 DIGITAL W/CAD | $606.90 | $867.00 | 30% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 DX BILAT MAMM0 DIGITAL W/CAD | $606.90 | $867.00 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 DX LT DIGITAL MAMMO /CAD | $505.93 | $722.75 | 30% |
| Diagnostic mammogram, one breast one side CPT 77065 DX RT DIGITAL MAMMO /CAD | $505.93 | $722.75 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DX RT DIGITAL MAMMO /CAD | $505.93 | $722.75 | 30% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 DX LT DIGITAL MAMMO /CAD | $505.93 | $722.75 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 ANKLE RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HIP RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 KNEE RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HIP LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE RIGHT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 ANKLE LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 KNEE LEFT MRI W/O CONTRAST | $2,902.55 | $4,146.50 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP RIGHT MRI W & W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE RIGHT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 KNEE LEFT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HIP LEFT MRI W & W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE RIGHT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 ANKLE LEFT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE LEFT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 ANKLE RIGHT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE LEFT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 KNEE RIGHT MRI W&W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP LEFT MRI W & W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HIP RIGHT MRI W & W/O CONTRAST | $3,252.03 | $4,645.75 | 30% |
| MRI of the brain, no contrast dye CPT 70551 BRAIN WITHOUT CONTRAST MRI LCD | $2,860.73 | $4,086.75 | 30% |
| MRI of the brain, no contrast dye inpatient CPT 70551 BRAIN WITHOUT CONTRAST MRI LCD | $2,860.73 | $4,086.75 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 BRAIN W & W/O CONTRAST MRI LCD | $3,109.40 | $4,442.00 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI PITUITARY W/WO CONTRAST | $3,109.40 | $4,442.00 | 30% |
| MRI of the brain, with and without contrast dye CPT 70553 IAC W/WO CONTRAST MRI LCD | $3,109.40 | $4,442.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI PITUITARY W/WO CONTRAST | $3,109.40 | $4,442.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 BRAIN W & W/O CONTRAST MRI LCD | $3,109.40 | $4,442.00 | 30% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 IAC W/WO CONTRAST MRI LCD | $3,109.40 | $4,442.00 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 LSPINE MRI CRITICAL CORD COMPR | $2,912.70 | $4,161.00 | 30% |
| MRI of the lower back, no contrast dye CPT 72148 LUMBAR SPINE W/O CONTRAST MRI | $2,912.70 | $4,161.00 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 LUMBAR SPINE W/O CONTRAST MRI | $2,912.70 | $4,161.00 | 30% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 LSPINE MRI CRITICAL CORD COMPR | $2,912.70 | $4,161.00 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US PREG >14 WEEKS SINGLE COMP. | $804.65 | $1,149.50 | 30% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US PREG >14 WEEKS SINGLE COMP. | $804.65 | $1,149.50 | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCREEN BILAT MAMMO DIGITAL/CAD | $550.38 | $786.25 | 30% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 SCREEN BILAT MAMMO DIGITAL/CAD | $550.38 | $786.25 | 30% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY | $4,756.85 | $6,795.50 | 30% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 POLYSOMNOGRAPHY | $4,756.85 | $6,795.50 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND ED | $554.93 | $792.75 | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL ULTRASOUND | $554.93 | $792.75 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ULTRASOUND | $554.93 | $792.75 | 30% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 TRANSVAGINAL ULTRASOUND ED | $554.93 | $792.75 | 30% |
| Ultrasound of the abdomen, complete CPT 76700 ABDOMINAL COMPLETE ULTRASOUND | $798.00 | $1,140.00 | 30% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 ABDOMINAL COMPLETE ULTRASOUND | $798.00 | $1,140.00 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 XR LSPINE W/FLEX/EXT | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 LUMBAR SPINE WITH OBLIQUES | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 LSPINE WITH FLEX AND EXT | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 XR LSPINE W/OBLIQUES | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 L SPINE W BENDING | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 L SPINE W BENDING | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LSPINE WITH FLEX AND EXT | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LSPINE W/OBLIQUES | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 XR LSPINE W/FLEX/EXT | $547.05 | $781.50 | 30% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 LUMBAR SPINE WITH OBLIQUES | $547.05 | $781.50 | 30% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 LAB-BASIC METABOLIC PANEL | $77.53 | $110.75 | 30% |
| Basic metabolic panel (blood test) inpatient CPT 80048 LAB-BASIC METABOLIC PANEL | $77.53 | $110.75 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $58.63 | $83.75 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LAB LIPID PANEL (ARP) | $99.58 | $142.25 | 30% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LAB LIPID PANEL (ARP) | $99.58 | $142.25 | 30% |
| Complete blood count (CBC) with differential CPT 85025 LAB CBC+PLT W/DIFF (ELEC) | $94.50 | $135.00 | 30% |
| Complete blood count (CBC) with differential CPT 85025 SVRCC CBC+PLT w/DIFF (ELECTRON | $94.50 | $135.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 LAB CBC+PLT W/DIFF (ELEC) | $94.50 | $135.00 | 30% |
| Complete blood count (CBC) with differential inpatient CPT 85025 SVRCC CBC+PLT w/DIFF (ELECTRON | $94.50 | $135.00 | 30% |
| Complete blood count (CBC), no differential CPT 85027 LAB CBC W/ PLATELETS | $53.73 | $76.75 | 30% |
| Complete blood count (CBC), no differential inpatient CPT 85027 LAB CBC W/ PLATELETS | $53.73 | $76.75 | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 LAB-COMP METABOLIC PANEL | $99.58 | $142.25 | 30% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 LAB-COMP METABOLIC PANEL | $99.58 | $142.25 | 30% |
| Kidney function blood test panel CPT 80069 LAB RENAL FUNCTION PANEL | $71.75 | $102.50 | 30% |
| Kidney function blood test panel inpatient CPT 80069 LAB RENAL FUNCTION PANEL | $71.75 | $102.50 | 30% |
| Liver function blood test panel CPT 80076 LAB HEPATIC FUNCTION PANEL | $85.75 | $122.50 | 30% |
| Liver function blood test panel inpatient CPT 80076 LAB HEPATIC FUNCTION PANEL | $85.75 | $122.50 | 30% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 LABS-PROSTATE-SPECIFIC AG,FREE | $96.08 | $137.25 | 30% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 LABS-PROSTATE-SPECIFIC AG,FREE | $96.08 | $137.25 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LAB-PROSTATE ANTIGEN, DIAG | $224.70 | $321.00 | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LABS-PROSTATE SPECIFIC AG,TOT | $224.70 | $321.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LABS-PROSTATE SPECIFIC AG,TOT | $224.70 | $321.00 | 30% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LAB-PROSTATE ANTIGEN, DIAG | $224.70 | $321.00 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LABS-APTT LUPUS ANTICOAG | $84.35 | $120.50 | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 LAB-PARTIAL THROMBOPLAST, TIME | $84.35 | $120.50 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LABS-APTT LUPUS ANTICOAG | $84.35 | $120.50 | 30% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LAB-PARTIAL THROMBOPLAST, TIME | $84.35 | $120.50 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 SVRCC PROTIME-INR | $30.10 | $43.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $30.10 | $43.00 | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 LAB-PROTHROMBIN TIME | $30.10 | $43.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 SVRCC PROTIME-INR | $30.10 | $43.00 | 30% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 LAB-PROTHROMBIN TIME | $30.10 | $43.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 LAB-TSH | $180.60 | $258.00 | 30% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 LAB-TSH | $180.60 | $258.00 | 30% |
| Urinalysis with microscope exam, automated CPT 81001 LAB-URINALYSIS W/SEDIMENT EXAM | $100.45 | $143.50 | 30% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 LAB-URINALYSIS W/SEDIMENT EXAM | $100.45 | $143.50 | 30% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS, DIP STICK/TABL | $15.93 | $22.75 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS DIP STICK AUTOMATED | $9.10 | $13.00 | 30% |
| Urinalysis without microscope exam, automated CPT 81003 LAB-URINALYSIS, ROUTINE | $99.58 | $142.25 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS DIP STICK AUTOMATED | $9.10 | $13.00 | 30% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 LAB-URINALYSIS, ROUTINE | $99.58 | $142.25 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS, DIP STICK/TABL | $9.10 | $13.00 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 LAB-URINE SPECIFIC GRAVITY | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 LAB-URINE PH | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 LAB-ACETONE,URINE | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual CPT 81002 SVRCC URINALYSIS, ROUTINE | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 LAB-URINE SPECIFIC GRAVITY | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 LAB-URINE PH | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 SVRCC URINALYSIS, ROUTINE | $40.25 | $57.50 | 30% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 LAB-ACETONE,URINE | $40.25 | $57.50 | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Cataract surgery with lens implant CPT 66984 EXTRACAPSULAR CATARACT REM | $1,093.93 | $1,562.75 | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 ROUTINE OBSTETRIC CARE W/A | $3,132.85 | $4,475.50 | 30% |
| Cesarean delivery, including prenatal and postpartum care CPT 59510 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, CESAREAN DELIVERY, AND POSTPARTUM CARE | $3,132.85 | $4,475.50 | 30% |
| Colonoscopy with endoscopic ultrasound CPT 45391 COLONOSCOPY, FLEXIBLE, PRO | $471.28 | $673.25 | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W REM TUMOR,LESION | $868.88 | $1,241.25 | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY, FLEXIBLE; W/R | $868.88 | $1,241.25 | 30% |
| Colonoscopy with polyp removal inpatient CPT 45385 COLONOSCOPY W REM TUMOR,LESION | $868.88 | $1,241.25 | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY W BIOPSY SING/MULT | $773.50 | $1,105.00 | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY, FLEXIBLE, PRO | $773.50 | $1,105.00 | 30% |
| Colonoscopy with tissue sample inpatient CPT 45380 COLONOSCOPY W BIOPSY SING/MULT | $773.50 | $1,105.00 | 30% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY, FLEXIBLE, PRO | $649.08 | $927.25 | 30% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY FLEX DIAG W/WO | $649.08 | $927.25 | 30% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY FLEX DIAG W/WO | $649.08 | $927.25 | 30% |
| Gallbladder removal, laparoscopic CPT 47562 LAPAROSCOPY, SURGICAL; CHO | $1,087.10 | $1,553.00 | 30% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 REPAIR, INITIAL INGUINAL H | $760.03 | $1,085.75 | 30% |
| Knee arthroscopy with meniscus trim CPT 29881 ARTHROSCOPY, KNEE, SURGICAL;WITH MENISCE | $1,507.28 | $2,153.25 | 30% |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 DISCISSION, SECONDARY MEMB | $466.03 | $665.75 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 EPIDURAL STEROID INJ LS/CAUDAL | $380.10 | $543.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR INTERLAMINAR EPID L2-3 | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 EPIDURAL LS TRANSLAMINAR CT IN | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 EPIDURAL LS TRANSLAMINAR INJ | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 LUMBAR INTERLAMINAR EPIDURAL | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance CPT 62323 CAUDAL EPIDURAL STEROID INJECT | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPIDURAL STEROID INJ LS/CAUDAL | $380.10 | $543.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR INTERLAMINAR EPIDURAL | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 CAUDAL EPIDURAL STEROID INJECT | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 LUMBAR INTERLAMINAR EPID L2-3 | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPIDURAL LS TRANSLAMINAR CT IN | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 EPIDURAL LS TRANSLAMINAR INJ | $1,925.70 | $2,751.00 | 30% |
| Lower-back epidural injection, without imaging guidance CPT 62322 LUMB INTRACATHECAL W/O IMG GUI | $219.10 | $313.00 | 30% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 LUMB INTRACATHECAL W/O IMG GUI | $219.10 | $313.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJECTION LUMBAR OR SACRAL,SINGLE LEVEL | $385.00 | $550.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 LS TRANSFORAMINAL EPIDURAL INJ | $385.00 | $550.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 EPIDURAL LS TRANSFORAMINAL -CT | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 EPIDURAL LS TRANSFORAMINAL | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 XR GUIDE LS TRANSFORAMINAL INJ | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 LS TRANSFORAMINAL EPIDURAL LT | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 LS TRANSFORAMINAL EPIDURAL RT | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 LS TRANSFORAMINAL EPIDURAL INJ | $385.00 | $550.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 EPIDURAL LS TRANSFORAMINAL | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 EPIDURAL LS TRANSFORAMINAL -CT | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 XR GUIDE LS TRANSFORAMINAL INJ | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 LS TRANSFORAMINAL EPIDURAL RT | $2,966.60 | $4,238.00 | 30% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 LS TRANSFORAMINAL EPIDURAL LT | $2,966.60 | $4,238.00 | 30% |
| Prostate biopsy CPT 55700 BX, PROSTATE; NEEDLE/PUNCH | $420.88 | $601.25 | 30% |
| Prostate removal (prostatectomy), laparoscopic CPT 55866 LAPS PRSTECT RETROPUBIC RA | $2,922.85 | $4,175.50 | 30% |
| Removal of a breast lump, open surgery CPT 19120 REMOVAL OF BREAST LESION | $694.05 | $991.50 | 30% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 ARTHROSCOPY,SHOULDER DECOMPRESSION | $1,717.28 | $2,453.25 | 30% |
| Tonsil and adenoid removal, child under 12 CPT 42820 TONSILLECTOMY & ADENOIDECT | $465.15 | $664.50 | 30% |
| Total hip replacement CPT 27130 ARTHROPLASTY, ACETABULAR AND PROXIMAL FE | $3,115.70 | $4,451.00 | 30% |
| Total knee replacement CPT 27447 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; | $3,462.20 | $4,946.00 | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY; W/BX, | $571.03 | $815.75 | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 UP GASTROINTESTINAL ENDO W BIO | $571.03 | $815.75 | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD WITH BIOPSY | $1,325.98 | $1,894.25 | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UP GASTROINTESTINAL ENDO W BIO | $571.03 | $815.75 | 30% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 EGD WITH BIOPSY | $1,325.98 | $1,894.25 | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GASTROINTESTINAL ENDO | $496.65 | $709.50 | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY; DX, W/ | $496.65 | $709.50 | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 Panendoscopy dx | $1,604.40 | $2,292.00 | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 UPPER GASTROINTESTINAL ENDO | $496.65 | $709.50 | 30% |
| Upper endoscopy (EGD), diagnostic inpatient CPT 43235 Panendoscopy dx | $1,604.40 | $2,292.00 | 30% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY, AND/OR FORCEPS) AND POSTPARTUM CARE, AFTER PREVIOUS CESAREAN DELIVERY | $2,912.35 | $4,160.50 | 30% |
| Vaginal birth after cesarean (VBAC), including prenatal and postpartum care CPT 59610 ROUTINE OBSTETRIC CARE, VA | $2,912.35 | $4,160.50 | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY, AND/OR FORCEPS) AND POSTPARTUM CARE | $2,768.33 | $3,954.75 | 30% |
| Vaginal delivery, including prenatal and postpartum care CPT 59400 ROUTINE OBSTETRIC CARE, AN | $2,768.33 | $3,954.75 | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 EKG W/INTERPRETATION | $116.55 | $166.50 | 30% |
| Family therapy with the patient, 50 minutes CPT 90847 FAMILY PSYCHOTHERAPY (CONJ | $186.90 | $267.00 | 30% |
| Family therapy without the patient, 50 minutes CPT 90846 FAMILY PSYCHOTHERAPY (W/O | $149.45 | $213.50 | 30% |
| Group psychotherapy session CPT 90853 GROUP PSYCHOTHERAPY (OTHER | $54.08 | $77.25 | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT ASTRA-ZENECA MEMORY CLINIC TRIAL | $83.24 | $118.91 | 30% |
| New patient office visit, about 30 minutes CPT 99203 HOSPITALIST NEW PATIENT L-3 | $182.00 | $260.00 | 30% |
| New patient office visit, about 30 minutes CPT 99203 PHYSICIAN OFFICE/OUTPT VISIT NEW LEVEL 3 | $182.00 | $260.00 | 30% |
| New patient office visit, about 30 minutes CPT 99203 NEW PATIENT VISIT LEVEL 3 | $182.00 | $260.00 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 NEW PATIENT VISIT LEVEL 3 | $182.00 | $260.00 | 30% |
| New patient office visit, about 30 minutes inpatient CPT 99203 HOSPITALIST NEW PATIENT L-3 | $182.00 | $260.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 PHYSICIAN OFFICE/OUTPT VISIT NEW LEVEL 4 | $227.50 | $325.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 OUT PATIENT LEVEL 4 | $227.50 | $325.00 | 30% |
| New patient office visit, about 45 minutes CPT 99204 NEW PATIENT VISIT LEVEL 4 | $227.50 | $325.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OUT PATIENT LEVEL 4 | $227.50 | $325.00 | 30% |
| New patient office visit, about 45 minutes inpatient CPT 99204 NEW PATIENT VISIT LEVEL 4 | $227.50 | $325.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 HOSPITALIST NEW PT L-5 | $287.00 | $410.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 PHYSICIAN OFFICE/OUTPT VISIT NEW LEVEL 5 | $287.00 | $410.00 | 30% |
| New patient office visit, about 60 minutes CPT 99205 NEW PATIENT VISIT LEVEL 5 | $287.00 | $410.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 HOSPITALIST NEW PT L-5 | $287.00 | $410.00 | 30% |
| New patient office visit, about 60 minutes inpatient CPT 99205 NEW PATIENT VISIT LEVEL 5 | $287.00 | $410.00 | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES (PER 15 MIN.) | $48.13 | $68.75 | 30% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PREVENT VISIT AGE 18-39 NEW | $195.83 | $279.75 | 30% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PREVENT VISIT AGE 40-64 NEW | $231.18 | $330.25 | 30% |
| Psychotherapy session, 30 minutes CPT 90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER | $90.30 | $129.00 | 30% |
| Psychotherapy session, 45 minutes CPT 90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER | $119.00 | $170.00 | 30% |
| Psychotherapy session, 60 minutes CPT 90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER | $178.50 | $255.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 OUTPATIENT CONSULT LEVEL 3 | $221.90 | $317.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 CONSULTATION DETAILED, HOSPITA | $221.90 | $317.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes CPT 99243 PHYS OFFICE/OUTPT CONSULT LEVEL 3 | $221.90 | $317.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OUTPATIENT CONSULT LEVEL 3 | $221.90 | $317.00 | 30% |
| Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 CONSULTATION DETAILED, HOSPITA | $221.90 | $317.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OUTPATIENT CONSULT LEVEL 4 | $326.90 | $467.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 CONSULTATION MOD./COMPLEX E.R. | $326.90 | $467.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 PHYS OFFICE/OUTPT CONSULT LEVEL 4 | $326.90 | $467.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OUTPATIENT CONSULT LEVEL 4 | $326.90 | $467.00 | 30% |
| Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 CONSULTATION MOD./COMPLEX E.R. | $326.90 | $467.00 | 30% |
Source file: https://svmc.org/222563241_Southwestern-Vermont-Medical-Center-Inc._standardcharges.csv