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 |
|---|---|---|---|---|
| Diagnostic laryngoscopy 31575 CPT 31575 | $549.45 | $549.45 | $65.36 – $237.10 | 8 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $521.70 | $521.70 | $46.73 – $436.66 | 8 |
| Diagnostic Mammogram (one breast) CPT 77065 | $370.75 | $370.75 | $37.96 – $310.32 | 8 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $382.24 – $382.24 | 1 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | not published | not published | $191.13 – $3,568.26 | 8 |
| Dialysis one evaluation CPT 90945 | not published | not published | $83.07 – $174.19 | 7 |
| Dialysis repeated eval CPT 90947 | not published | not published | $119.62 – $246.05 | 7 |
| Dialysis training complete CPT 90989 | not published | not published | $619.14 – $854.04 | 3 |
| Dialysis training incompl CPT 90993 | not published | not published | $134.18 – $185.05 | 3 |
| Diathermy eg microwave CPT 97024 | not published | not published | $6.99 – $14.92 | 7 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $480.24 | $480.24 | $0.07 – $264.97 | 8 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $170.64 | $170.64 | $5.45 – $160.40 | 8 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $20.33 – $29.46 | 7 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.24 – $0.48 | 3 |
| Diffusing capacity CPT 94729 | $368.05 | $368.05 | $8.67 – $71.50 | 8 |
| Digital analysis of eeg CPT 95957 | not published | not published | $98.71 – $201.98 | 7 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $172.26 – $364.65 | 7 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $8.37 | $8.37 | $2.51 – $7.87 | 8 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $15,127.93 | $15,127.93 | $4,538.38 – $14,220.25 | 8 |
| Digoxin total therapeutic drug level CPT 80162 | $145.60 | $145.60 | $13.28 – $136.86 | 8 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $42.34 – $81.11 | 7 |
| Dilate biliary duct/ampulla CPT 47542 | not published | not published | $130.68 – $941.21 | 8 |
| Dilate esophagus CPT 43453 | not published | not published | $82.73 – $1,492.77 | 8 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $76.53 – $361.07 | 8 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $325.88 – $666.96 | 6 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $162.94 – $333.47 | 6 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $463.87 – $949.59 | 6 |
| Dilate tear duct opening CPT 68801 | not published | not published | $75.22 – $185.68 | 8 |
| Dilate urethra stricture CPT 53600 | not published | not published | $61.60 – $170.89 | 8 |
| Dilate urethra stricture CPT 53601 | not published | not published | $51.28 – $153.69 | 8 |
| Dilate urethra stricture CPT 53605 | not published | not published | $61.83 – $128.79 | 7 |
| Dilate urethra stricture CPT 53621 | not published | not published | $68.94 – $296.13 | 8 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $39.93 – $136.94 | 8 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $163.57 – $351.09 | 7 |
| Dilation of cervical canal 57800 CPT 57800 | $8,572.80 | $8,572.80 | $45.89 – $150.98 | 8 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $185.55 – $397.86 | 7 |
| Dilation of salivary duct CPT 42660 | not published | not published | $83.88 – $216.52 | 8 |
| Dilation of urethra CPT 53661 | not published | not published | $39.03 – $134.47 | 8 |
| Dilation of urethra CPT 53665 | not published | not published | $36.65 – $75.23 | 7 |
| Dilation of vagina CPT 57400 | not published | not published | $124.95 – $265.70 | 7 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $56.62 – $144.55 | 8 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $83.42 – $327.66 | 8 |
| Dilat xst trc ndurlgc px CPT 50436 | not published | not published | $142.97 – $304.34 | 7 |
| Dilat xst trc new access rcs CPT 50437 | not published | not published | $239.21 – $505.63 | 7 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $54.55 – $181.37 | 4 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $7.38 – $17.14 | 7 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $2,219.47 | $2,219.47 | $651.47 – $2,086.30 | 8 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | not published | not published | $0.02 – $0.67 | 3 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $7.13 | $7.13 | $0.80 – $6.70 | 8 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $35.25 – $104.50 | 3 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $3.72 – $7.65 | 7 |
| Direct advanced life support CPT 99288 | not published | not published | $403.47 – $403.47 | 1 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $25.88 – $59.64 | 7 |
| Disability dlco CPT 94727 | $464.85 | $464.85 | $11.71 – $23.72 | 8 |
| Disaccharidases CPT 82657 | $738.60 | $738.60 | $22.17 – $694.28 | 8 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $455.15 – $988.23 | 7 |
| Disarticulation shoulder CPT 23920 | not published | not published | $1,077.52 – $2,319.44 | 7 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $1,446.19 – $2,999.26 | 7 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $192.50 – $422.94 | 7 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $55.07 – $112.52 | 7 |
| Disconnect insert locking wr HCPCS L6616 | not published | not published | $68.07 – $180.54 | 3 |
| Disconnect locking wrist uni HCPCS L6615 | not published | not published | $164.70 – $436.90 | 3 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $92.72 – $197.91 | 7 |
| Dissect brain w/scope CPT 62161 | not published | not published | $1,433.84 – $3,168.05 | 7 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | not published | not published | $94.56 – $197.91 | 6 |
| Dissolve clot heart vessel CPT 92975 | not published | not published | $351.70 – $745.58 | 7 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $1,068.18 – $2,270.63 | 7 |
| Div aberrant vsl w/reanast CPT 33803 | not published | not published | $1,083.26 – $2,311.98 | 7 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $765.11 – $1,623.33 | 7 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $327.11 – $689.31 | 7 |
| #d/lmeth-l-methamphetamine CPT 80374 | not published | not published | $11.80 – $50.16 | 3 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | not published | not published | $275.18 – $583.58 | 7 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $279.00 – $584.63 | 6 |
| Dmpk gene charac alleles CPT 81239 | not published | not published | $274.83 – $575.89 | 6 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $287.07 | 6 |
| Dna antibody native/double stranded CPT 86225 | $149.60 | $149.60 | $13.74 – $140.62 | 8 |
| Dna gardnerella CPT 87510 | not published | not published | $20.05 – $42.01 | 6 |
| Dna probe chlamydia CPT 87490 | not published | not published | $22.75 – $47.44 | 6 |
| Dna probe gc CPT 87590 | not published | not published | $26.88 – $56.26 | 6 |
| Dna trichomonas CPT 87660 | not published | not published | $20.05 – $42.01 | 6 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $117.10 | $117.10 | $6.66 – $110.07 | 8 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $150.55 | $150.55 | $0.47 – $141.52 | 8 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $103.22 – $103.22 | 1 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $6.17 – $7.46 | 3 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $61.52 – $115.90 | 3 |
| Domicil/r-home visit est pat CPT 99334 | not published | not published | $95.71 – $95.71 | 1 |
| Domicil/r-home visit est pat CPT 99335 | not published | not published | $149.75 – $149.75 | 1 |
| Domicil/r-home visit est pat CPT 99336 | not published | not published | $211.13 – $211.13 | 1 |
| Domicil/r-home visit est pat CPT 99337 | not published | not published | $304.58 – $304.58 | 1 |
| Domicil/r-home visit new pat CPT 99324 | not published | not published | $87.82 – $87.82 | 1 |
| Domicil/r-home visit new pat CPT 99325 | not published | not published | $127.80 – $127.80 | 1 |
| Domicil/r-home visit new pat CPT 99326 | not published | not published | $220.13 – $220.13 | 1 |
| Domicil/r-home visit new pat CPT 99327 | not published | not published | $293.87 – $293.87 | 1 |
| Domicil/r-home visit new pat CPT 99328 | not published | not published | $340.61 – $340.61 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $87.83 | $87.83 | $0.64 – $22.91 | 8 |
| Doppler echo complete CPT 93320 | $934.10 | $934.10 | $17.42 – $781.84 | 8 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | not published | not published | $68.34 – $143.01 | 7 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $675.40 | $675.40 | $20.97 – $565.31 | 8 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $349.10 | $349.10 | $11.73 – $292.20 | 8 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | not published | not published | $0.81 – $1.36 | 3 |
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.