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 |
|---|---|---|---|---|
| X-ray head for orthodontia CPT 70350 | not published | not published | $8.29 – $17.62 | 7 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $504.15 | $504.15 | $12.99 – $27.11 | 8 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $958.45 | $958.45 | $14.92 – $802.22 | 8 |
| X-ray joint survey 1 view CPT 77077 | $39.00 | $39.00 | $6.00 – $33.21 | 8 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $238.60 | $238.60 | $7.63 – $199.71 | 8 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $482.65 | $482.65 | $10.65 – $403.98 | 8 |
| X-ray male genital tract CPT 74440 | not published | not published | $17.42 – $35.92 | 7 |
| X-ray mandible ltd <4 views CPT 70100 | $256.15 | $256.15 | $8.64 – $214.40 | 8 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $15.95 – $18.34 | 4 |
| X-ray nose to rectum for foreign body child CPT 76010 | $252.05 | $252.05 | $8.64 – $210.97 | 8 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $21.01 – $42.70 | 7 |
| X-ray optic foramina CPT 70190 | not published | not published | $10.61 – $21.69 | 7 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $158.13 – $330.09 | 7 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $180.48 – $377.53 | 7 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $1,290.05 | $1,290.05 | $22.50 – $49.47 | 8 |
| X-ray ribs 2 views left CPT 71100 | $260.15 | $260.15 | $4.50 – $21.69 | 8 |
| X-ray sella turcica CPT 70240 | not published | not published | $8.99 – $18.29 | 7 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $434.05 | $434.05 | $24.57 – $363.30 | 8 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $900.50 | $900.50 | $27.83 – $753.72 | 8 |
| X-ray small intestine follow-through study CPT 74248 | $1,586.30 | $1,586.30 | $32.92 – $1,327.73 | 8 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $318.20 | $318.20 | $10.33 – $266.33 | 8 |
| X-ray surgical specimen CPT 76098 | $292.50 | $292.50 | $14.92 – $244.82 | 8 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $304.60 | $304.60 | $12.34 – $254.95 | 8 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $27.87 – $56.26 | 7 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $106.48 – $544.27 | 7 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $68.90 – $143.01 | 7 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $1,479.00 – $6,263.55 | 3 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $12.91 – $27.05 | 6 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.29 – $2.95 | 7 |
| Yersinia antibody CPT 86793 | not published | not published | $13.19 – $27.64 | 6 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $63,005.77 – $198,557.73 | 4 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $236.09 – $499.25 | 7 |
| Ziconotide injection HCPCS J2278 | not published | not published | $9.04 – $19.32 | 7 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | not published | not published | $1.51 – $3.00 | 7 |
| Zidovudine, oral, 100 mg HCPCS S0104 | not published | not published | $1.55 – $2.70 | 2 |
| Zika virus dna/rna amp probe CPT 87662 | not published | not published | $51.31 – $107.52 | 6 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $35.25 | 6 |
| Zinc paste band w >=3"<5"/yd HCPCS A6456 | not published | not published | $1.40 – $3.67 | 3 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $326.60 | $326.60 | $8.08 – $307.00 | 8 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $6.68 – $15.78 | 7 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $1,368.63 | $1,368.63 | $5.73 – $357.37 | 8 |
| Zoster vaccine-live inj CPT 90736 | not published | not published | $216.92 – $278.57 | 3 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $109.62 – $404.65 | 6 |
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.