Franklin Memorial Hospital
111 Franklin Health Commons, Farmington, ME · MaineHealth · · NPI 1922791417
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Subtalar arthro w/fb rmvl CPT 29904 | not published | not published | $615.92 – $1,335.27 | 7 |
| Subtalar arthro w/fusion CPT 29907 | not published | not published | $843.38 – $1,818.54 | 7 |
| Subtemporal cranial dcmprn CPT 61340 | not published | not published | $1,357.41 – $2,996.56 | 7 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $57.99 | $57.99 | $0.82 – $54.51 | 8 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $864.75 – $15,893.79 | 2 |
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $2,766.13 – $15,893.79 | 2 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $864.75 – $15,893.79 | 2 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $770.96 – $7,941.46 | 2 |
| Suction socket HCPCS L6686 | not published | not published | $746.28 – $1,979.70 | 3 |
| Suction susp ak/knee disart HCPCS L5652 | not published | not published | $510.74 – $1,354.87 | 3 |
| Sugars multiple quant CPT 84379 | not published | not published | $11.53 – $24.16 | 6 |
| Sugars single quant CPT 84378 | not published | not published | $11.53 – $24.16 | 6 |
| Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution HCPCS C9399 | $10,080.30 | $10,080.30 | $320.80 – $1,005.16 | 8 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $69.93 | $69.93 | $20.98 – $65.73 | 8 |
| Sulfonylurea screen qn-sendout CPT 80377 | not published | not published | $7.77 – $50.16 | 3 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $61.34 | $61.34 | $18.40 – $57.66 | 8 |
| Sup/ext non-ins inf pump syr HCPCS K0552 | not published | not published | $2.64 – $7.08 | 3 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | not published | not published | $3.23 – $32.13 | 8 |
| Supply of digital device HCPCS G0552 | not published | not published | $559.47 – $559.47 | 1 |
| Supp non-insulin inf cath/wk HCPCS A4221 | not published | not published | $19.71 – $52.78 | 3 |
| Support clav 29.6-40.5in med HCPCS L3650 | not published | not published | $64.01 – $169.79 | 3 |
| Supprelin la implant HCPCS J9226 | not published | not published | $44,158.25 – $89,474.69 | 7 |
| Suprv interfacilty transport CPT 99485 | not published | not published | $72.24 – $147.08 | 6 |
| Suprv interfac trnsport addl CPT 99486 | not published | not published | $62.37 – $127.42 | 6 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $100.56 – $216.90 | 7 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | not published | not published | $778.57 – $1,672.81 | 7 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | not published | not published | $778.79 – $1,673.50 | 7 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $409.70 – $871.66 | 7 |
| Surgery of pancreatic cyst CPT 48500 | not published | not published | $1,096.39 – $2,353.32 | 7 |
| Surgery to stop leg growth CPT 27475 | not published | not published | $640.17 – $1,382.04 | 7 |
| Surgery to stop leg growth CPT 27477 | not published | not published | $707.33 – $1,526.40 | 7 |
| Surgery to stop leg growth CPT 27479 | not published | not published | $883.31 – $1,900.56 | 7 |
| Surgery to stop leg growth CPT 27485 | not published | not published | $648.75 – $1,401.01 | 7 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $842.39 – $1,778.54 | 7 |
| Surgical opening esophagus CPT 43351 | not published | not published | $1,245.61 – $2,673.25 | 7 |
| Surgical opening esophagus CPT 43352 | not published | not published | $1,008.90 – $2,164.90 | 7 |
| Surgical opening of stomach CPT 43510 | not published | not published | $761.55 – $1,952.74 | 7 |
| Surgical opening of stomach 43500 CPT 43500 | not published | not published | $748.67 – $1,617.24 | 7 |
| Surgical opening of throat CPT 42955 | not published | not published | $731.79 – $1,541.99 | 7 |
| Surgical pathology level 1 gross examination only CPT 88300 | $78.15 | $78.15 | $4.24 – $25.00 | 8 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $168.55 | $168.55 | $6.60 – $51.50 | 8 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $168.55 | $168.55 | $10.95 – $65.50 | 8 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $275.85 | $275.85 | $36.16 – $111.00 | 8 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $429.35 | $429.35 | $79.63 – $359.37 | 8 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,110.10 | $1,110.10 | $140.22 – $929.15 | 8 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | not published | not published | $1,283.08 – $2,751.18 | 7 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | not published | not published | $1,452.91 – $3,117.88 | 7 |
| Surgical revision intestine CPT 44680 | not published | not published | $1,026.01 – $2,203.52 | 7 |
| Surgical trays HCPCS A4550 | not published | not published | $39.98 – $39.98 | 1 |
| Surgigraft, 1 sq cm HCPCS Q4183 | not published | not published | $85.00 – $209.54 | 3 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $406.14 – $1,092.19 | 8 |
| Susceptibility agar dilution per agent CPT 87181 | $54.00 | $54.00 | $4.75 – $50.76 | 8 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $35.05 | $35.05 | $4.75 – $32.95 | 8 |
| Susceptibility mic per plate CPT 87186 | $97.25 | $97.25 | $8.65 – $91.42 | 8 |
| Suscept studies macrobroth dilution ea CPT 87188 | not published | not published | $6.64 – $13.91 | 6 |
| Suspend bowel w/prosthesis CPT 44700 | not published | not published | $958.28 – $2,028.65 | 7 |
| Suspension of testis CPT 54620 | not published | not published | $287.70 – $609.35 | 7 |
| Suspension of uterus CPT 58410 | not published | not published | $792.32 – $1,663.31 | 7 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $449.89 – $943.49 | 7 |
| Suspension sleeve lower ext HCPCS L2397 | not published | not published | $109.73 – $291.08 | 3 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $1,005.91 – $2,146.58 | 7 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $1,314.61 – $2,819.64 | 7 |
| Svc venogram s&i CPT 75827 | not published | not published | $52.25 – $107.10 | 7 |
| Swallowing Evaluation (Bedside) CPT 92610 | $479.90 | $479.90 | $68.98 – $164.47 | 8 |
| Swallowing Therapy Session CPT 92526 | $277.70 | $277.70 | $83.19 – $232.43 | 8 |
| Sweat collection by iontophoresis CPT 89230 | $51.70 | $51.70 | $2.42 – $43.27 | 8 |
| Symes ankle without (sach) foot HCPCS L5703 | not published | not published | $2,241.47 – $5,946.07 | 3 |
| Symes met fr leath socket ar HCPCS L5060 | not published | not published | $2,618.61 – $6,946.54 | 3 |
| Symes type medial opening so HCPCS L5636 | not published | not published | $322.10 – $854.43 | 3 |
| Symes type poster opening so HCPCS L5634 | not published | not published | $375.21 – $995.35 | 3 |
| Symes type ptb brim design s HCPCS L5632 | not published | not published | $239.92 – $636.49 | 3 |
| Syme typ expandabl wall sckt HCPCS L5630 | not published | not published | $484.52 – $1,285.32 | 3 |
| Sympathectomy cervical CPT 64802 | not published | not published | $800.17 – $1,773.12 | 7 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $737.30 – $1,584.69 | 7 |
| Sympathectomy lumbar CPT 64818 | not published | not published | $747.86 – $1,607.74 | 7 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $761.42 – $1,642.99 | 7 |
| Sympathectomy thoracolumbar CPT 64809 | not published | not published | $1,029.11 – $2,273.34 | 7 |
| Synch audio-only est high 40 CPT 98015 | $264.60 | $264.60 | $132.30 – $198.45 | 3 |
| Synch audio-only est low 20 CPT 98013 | $121.10 | $121.10 | $60.55 – $90.83 | 3 |
| Synch audio-only est mod 30 CPT 98014 | $179.20 | $179.20 | $89.60 – $134.40 | 3 |
| Synch audio-only est sf 10 CPT 98012 | $66.50 | $66.50 | $33.25 – $49.88 | 3 |
| Synch audio-only new high 60 CPT 98011 | $324.80 | $324.80 | $162.40 – $243.60 | 3 |
| Synch audio-only new low 30 CPT 98009 | $156.80 | $156.80 | $78.40 – $117.60 | 3 |
| Synch audio-only new mod 45 CPT 98010 | $247.10 | $247.10 | $123.55 – $185.33 | 3 |
| Synch audio-only new sf 15 CPT 98008 | $90.30 | $90.30 | $45.15 – $67.73 | 3 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $10.29 – $17.60 | 7 |
| Synthetic sentence id test CPT 92576 | not published | not published | $32.12 – $92.18 | 7 |
| Synvisc or synvisc-one HCPCS J7325 | $4,165.57 | $4,165.57 | $8.82 – $1,957.82 | 8 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $37.35 | $37.35 | $4.40 – $35.11 | 8 |
| T3 (triiodothyronine) free CPT 84481 | $186.00 | $186.00 | $16.94 – $174.84 | 8 |
| T3 (triiodothyronine) total CPT 84480 | $155.05 | $155.05 | $14.18 – $145.75 | 8 |
| T4 (thyroxine) free CPT 84439 | $99.80 | $99.80 | $9.02 – $93.81 | 8 |
| T4 (thyroxine) total CPT 84436 | $78.15 | $78.15 | $6.87 – $73.46 | 8 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $0.53 – $1.13 | 7 |
| Tacrol envarsus ex rel oral HCPCS J7503 | not published | not published | $1.65 – $3.56 | 7 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | not published | not published | $0.24 – $0.36 | 7 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | not published | not published | $238.60 – $503.43 | 7 |
| Tacrolimus therapeutic drug level CPT 80197 | $82.25 | $82.25 | $13.26 – $77.32 | 8 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | not published | not published | $13.41 – $27.62 | 7 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $2,089.78 – $4,424.68 | 7 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.