Springfield Medical Care System
25 Ridgewood Road Springfield, VT 05156
Medical Procedures
Radiology Services
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| CT - Abdomen & Pelvis, with contrast | $3684 | 0% | $3684 | Medium |
| CT - Chest (outpatient) | $1573 | 0% | $1573 | Medium |
| Mammogram (outpatient) | $646 | 0% | $646 | Medium |
| MRI - Knee (outpatient) | $1642 | 0% | $1642 | Medium |
| Myocardial Imaging (outpatient) | $4710 | 0% | $4710 | Medium |
| Ultrasound - Abdominal, Limited | $1029 | 0% | $1029 | Medium |
| Ultrasound - Head and Neck | $1019 | 0% | $1019 | Medium |
| Ultrasound - Pregnancy (outpatient) | $1253 | 0% | $1253 | Medium |
| Ultrasound - Transvaginal (non-maternity) | $1347 | 0% | $1347 | Medium |
| X-Ray - Abdomen | $404 | 0% | $404 | Medium |
| X-Ray - Ankle (outpatient) | $306 | 0% | $306 | Medium |
| X-Ray - Chest (outpatient) | $627 | 0% | $627 | Medium |
| X-Ray - Foot (outpatient) | $558 | 0% | $558 | Medium |
| X-Ray - Hand | $460 | 0% | $460 | Medium |
| X-Ray - Hip | $651 | 0% | $651 | Medium |
| X-Ray - Knee (outpatient) | $526 | 0% | $526 | Medium |
| X-Ray - Shoulder (outpatient) | $497 | 0% | $497 | Medium |
| X-Ray - Wrist (outpatient) | $588 | 0% | $588 | Medium |
Outpatient Tests and Procedures
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Arthrocentesis (outpatient) | $808 | 0% | $808 | Medium |
| Colonoscopy with polyp removal (outpatient) | $4385 | 0% | $4385 | High |
| Diagnostic colonoscopy (outpatient) | $3988 | 0% | $3988 | Medium |
Laboratory Services
Physical Therapy
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Low Complexity Evaluation - PT | $147 | 0% | $147 | Medium |
| Moderate Complexity Evaluation - PT | $234 | 0% | $234 | Medium |
| High Complexity Evaluation - PT | $291 | 0% | $291 | Medium |
| Manual Therapy - PT | $81 | 0% | $81 | Medium |
| Therapeutic Exercises - PT | $81 | 0% | $81 | Medium |
| Neuromuscular Reeducation - PT | $76 | 0% | $76 | Medium |
| Ultrasound Therapy - PT | $65 | 0% | $65 | Medium |
Behavioral Health Care
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| 30 Minute - Psychotherapy | $80 | 0% | $80 | Medium |
| 45 Minute - Psychotherapy | $109 | 0% | $109 | Medium |
| 60 Minute - Psychotherapy | $151 | 0% | $151 | Medium |
| Diagnostic Evaluation - Psychiatric | $194 | 0% | $194 | Medium |
| Group Session - Psychotherapy | $185 | 0% | $185 | Medium |
Office Visits
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Basic Office Visit | $71 | 0% | $71 | Medium |
| Office Visit, Established Pt | $106 | 0% | $106 | Medium |
| Office Visit of Moderate Complexity | $161 | 0% | $161 | Medium |
| Office Visit of Moderate to High Complexity | $206 | 0% | $206 | Medium |
| Office Visit, New Pt, Minor | $125 | 0% | $125 | Medium |
| Comp Preventive Medicine younger than 1 yrs old | $183 | 0% | $183 | Medium |
| Comp Preventive Medicine 1-4 yrs old | $191 | 0% | $191 | Medium |
| Comp Preventive Medicine 5-11 yrs old | $203 | 0% | $203 | Medium |
| Comp Preventive Medicine 12-17 yrs old | $223 | 0% | $223 | Medium |
| Comp Preventive Medicine 18-39 yrs old | $224 | 0% | $224 | Medium |
| Comp Preventive Medicine 40-64 yrs old | $245 | 0% | $245 | Medium |
Emergency Visits
| Procedure | Estimate of Total Cost | Uninsured Discount | What you Will Pay | Typical Patient Complexity |
|---|---|---|---|---|
| Emergency Room Visit - Very Minor (outpatient) | $276 | 0% | $276 | Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $310 | 0% | $310 | Medium |
| Emergency Room Visit - Medium (outpatient) | $581 | 0% | $581 | Medium |