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 |
|---|---|---|---|---|
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $959.10 – $2,058.47 | 7 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $693.99 – $1,458.63 | 7 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $1,519.26 – $3,254.13 | 7 |
| Drng salivary gland simple 42300 CPT 42300 | $3,988.50 | $3,988.50 | $151.29 – $418.25 | 8 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $130.71 – $330.86 | 8 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $0.63 – $3.65 | 7 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $59.28 | $59.28 | $6.10 – $55.72 | 8 |
| Drop lock knee HCPCS L2182 | not published | not published | $108.71 – $288.39 | 3 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $30.51 – $80.95 | 3 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $729.42 | $729.42 | $218.83 – $685.65 | 8 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $12.36 – $24.66 | 7 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | not published | not published | $11.79 – $23.87 | 7 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $336.20 | $336.20 | $7.84 – $316.03 | 8 |
| Drsg sht 5.625x4.625in std HCPCS A6025 | not published | not published | $25.89 – $33.21 | 2 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | not published | not published | $12.15 – $32.02 | 3 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $188.42 – $188.42 | 1 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $16.91 – $60.10 | 7 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $48.58 – $103.58 | 7 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $168.77 – $168.77 | 1 |
| Drug admin & hemodynmic meas CPT 93463 | not published | not published | $94.85 – $194.52 | 7 |
| Drug assay caffeine CPT 80155 | not published | not published | $25.72 – $80.65 | 6 |
| Drug assay posaconazole CPT 80187 | $207.20 | $207.20 | $15.37 – $194.77 | 8 |
| Drug assay rufinamide CPT 80210 | not published | not published | $15.37 – $56.81 | 6 |
| Drug assay vedolizumab CPT 80280 | $484.30 | $484.30 | $21.88 – $455.24 | 8 |
| Drug assay voriconazole CPT 80285 | $174.95 | $174.95 | $15.37 – $164.45 | 8 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $10.58 – $39.06 | 6 |
| Drug of abuse screen urine CPT 80305 | $46.65 | $46.65 | $10.21 – $34.50 | 8 |
| Drug screening tapentadol CPT 80372 | not published | not published | $12.30 – $50.16 | 3 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $27.11 – $56.81 | 6 |
| Drug/substance nos 4-6 CPT 80376 | not published | not published | $7.77 – $50.16 | 3 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $198.74 – $416.17 | 6 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $106.56 – $239.78 | 6 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $246.92 – $517.15 | 6 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $328.06 | 6 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $63.38 – $130.15 | 6 |
| Drug test prsmv instrmnt CPT 80306 | $66.10 | $66.10 | $17.14 – $62.13 | 8 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $156.10 | $156.10 | $46.83 – $146.73 | 8 |
| Drvvt confirm - quest CPT 85597 | not published | not published | $8.49 – $37.68 | 6 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $242.79 – $565.37 | 8 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $5,515.95 | $5,515.95 | $141.02 – $749.11 | 8 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $194.97 – $516.66 | 8 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $164.12 – $442.12 | 8 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $191.77 – $502.10 | 8 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $259.36 – $640.90 | 8 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $496.18 – $2,381.72 | 5 |
| Ductogram sgl duct CPT 77053 | not published | not published | $16.96 – $34.57 | 7 |
| Duodenal exclusion CPT 48547 | not published | not published | $1,705.15 – $3,655.38 | 7 |
| Duodenal motility study CPT 91022 | not published | not published | $70.70 – $143.68 | 7 |
| Duplex scan bilateral study 93985 CPT 93985 | not published | not published | $36.61 – $76.59 | 7 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $22.92 – $46.10 | 7 |
| Dup scan/hemodialysis access 93990 CPT 93990 | not published | not published | $19.33 – $46.10 | 7 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | not published | not published | $23.33 – $47.44 | 7 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $975.95 | $975.95 | $34.91 – $816.87 | 8 |
| Duragen 1x1 5ea/bx HCPCS C9354 | not published | not published | $19.38 – $19.38 | 1 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $12,805.67 | $12,805.67 | $80.14 – $2,888.97 | 8 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $14.35 – $28.48 | 7 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $119.55 – $679.24 | 6 |
| Dx aly aud oi snd prcsr each CPT 92623 | not published | not published | $31.67 – $39.20 | 5 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $126.83 – $527.46 | 8 |
| Dx bronchoscope/lavage 31624 CPT 31624 | not published | not published | $128.75 – $490.85 | 8 |
| Dx bronchoscope/wash 31622 CPT 31622 | $4,843.05 | $4,843.05 | $126.19 – $480.57 | 8 |
| Dx dark adaptation exam i&r CPT 92284 | not published | not published | $14.78 – $64.51 | 7 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $48.89 – $530.68 | 8 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $73.97 – $712.50 | 8 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $35.64 – $437.22 | 8 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $57.17 – $373.36 | 8 |
| Dx intraop epcar Ultrasound chd i&r CPT 76989 | not published | not published | $62.66 – $72.52 | 5 |
| Dx intraop epicar car Ultrasound chd CPT 76987 | not published | not published | $168.40 – $193.18 | 5 |
| Dx intraop thoracic aorta Ultrasound CPT 76984 | not published | not published | $54.59 – $63.03 | 5 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $150.39 – $319.24 | 7 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $150.96 – $320.60 | 7 |
| Dx ntrop epcr Ultrasound chd img acq CPT 76988 | not published | not published | $106.97 – $122.00 | 5 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $110.86 – $256.59 | 8 |
| Dynamic fine wire emg CPT 96003 | not published | not published | $16.45 – $31.48 | 6 |
| Dynamic surface emg CPT 96002 | not published | not published | $21.01 – $43.38 | 7 |
| Ear and throat examination CPT 92502 | not published | not published | $91.98 – $193.85 | 7 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $61.17 – $279.47 | 8 |
| Ear cartilage graft CPT 21235 | not published | not published | $549.33 – $1,429.48 | 8 |
| Ear irrigation 69209 CPT 69209 | $209.80 | $209.80 | $14.30 – $31.85 | 8 |
| Ear protector evaluation CPT 92596 | not published | not published | $32.12 – $162.67 | 7 |
| Ecallantide injection HCPCS J1290 | not published | not published | $530.91 – $1,113.14 | 7 |
| Ecg/1-3 leads/interp & report only 93042 CPT 93042 | not published | not published | $6.66 – $13.56 | 7 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $186.00 | $186.00 | $5.54 – $155.68 | 8 |
| Ecg < 30 days transmission & analysis CPT 93271 | $441.40 | $441.40 | $117.54 – $369.45 | 8 |
| Ecg external < 48 hours recording CPT 93225 | $395.00 | $395.00 | $17.12 – $330.62 | 8 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $163.10 | $163.10 | $33.70 – $136.51 | 8 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $399.65 | $399.65 | $11.17 – $334.51 | 8 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $399.65 | $399.65 | $11.17 – $334.51 | 8 |
| Ecg record/review CPT 93268 | not published | not published | $117.54 – $342.29 | 7 |
| Ecg/review interpret only CPT 93272 | not published | not published | $23.75 – $48.13 | 7 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $2,480.40 | $2,480.40 | $67.32 – $2,076.09 | 8 |
| Echocardiogram (Limited Follow-Up Heart Ultrasound) CPT 93308 | $865.55 | $865.55 | $24.40 – $724.47 | 8 |
| Echocardiography doppler color flow mapping CPT 93325 | $777.00 | $777.00 | $3.05 – $650.35 | 8 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $2,480.40 | $2,480.40 | $691.75 – $2,331.58 | 8 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $1,007.60 | $1,007.60 | $302.28 – $947.14 | 8 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $553.00 | $553.00 | $6.98 – $462.86 | 8 |
| Echo exam of eye CPT 76516 | not published | not published | $21.87 – $45.41 | 7 |
| Echo exam of eye CPT 76519 | not published | not published | $29.53 – $61.00 | 7 |
| Echo exam of eye CPT 76529 | not published | not published | $31.19 – $63.03 | 7 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $6.19 – $14.78 | 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.