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Northern Light Mayo Hospital

897 West Main Street, Dover Foxcroft, ME 04426 · (207) 564-4251

Critical Access HospitalsGovernment - Hospital District or AuthorityCMS rating 2/5Website ↗Website taken from the domain of its price file

Price file

Prices published

File dated 2026-03-30

3,982 price rows for 62 procedures

Published prices

cash · negotiated range · list
Basic metabolic panel (blood test)

CPT 80048 · lowest of 6 lines

$63
cash
$1,495
cash
CT scan of the head, no contrast

CPT 70450 · lowest of 4 lines

$566
cash
CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines

$590
cash
—
cash
$3,979
cash
Chlamydia test (DNA)

CPT 87491 · lowest of 16 lines

$36
cash
Colonoscopy (diagnostic)

CPT 45378 · lowest of 8 lines

$344
cash
Colonoscopy with biopsy

CPT 45380 · lowest of 2 lines

$413
cash
Colonoscopy with polyp removal

CPT 45385 · lowest of 2 lines

$462
cash
Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines

$40
cash
Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 4 lines

$94
cash
Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 4 lines

$175
cash
Electrocardiogram (ECG) with interpretation

CPT 93000 · lowest of 4 lines

$30
cash
$113
cash
Family psychotherapy with the patient

CPT 90847 · lowest of 2 lines

$148
cash
—
cash
Gallbladder removal (laparoscopic)

CPT 47562 · lowest of 2 lines

$625
cash
Gonorrhea test (DNA)

CPT 87591 · lowest of 6 lines

$41
cash
—
cash
Inguinal hernia repair (age 5 and up)

CPT 49505 · lowest of 2 lines

$375
cash
Knee arthroscopy with meniscus repair

CPT 29881 · lowest of 2 lines

$601
cash
—
cash
—
cash
Lipid panel (cholesterol test)

CPT 80061 · lowest of 10 lines

$45
cash
Liver function panel

CPT 80076 · lowest of 2 lines

$48
cash
MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines

$810
cash
—
cash
$610
cash
MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines

$618
cash
$182
cash
New patient office visit (about 30 minutes)

CPT 99203 · lowest of 8 lines

$83
cash
New patient office visit (about 45 minutes)

CPT 99204 · lowest of 8 lines

$125
cash
New patient office visit (about 60 minutes)

CPT 99205 · lowest of 10 lines

$164
cash
PSA test (prostate)

CPT 84153 · lowest of 2 lines

$49
cash
$23
cash
$44
cash
Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 6 lines

$241
cash
Preventive visit, new patient age 18 to 39

CPT 99385 · lowest of 4 lines

$67
cash
Preventive visit, new patient age 40 to 64

CPT 99386 · lowest of 4 lines

$80
cash
Prostate biopsy

CPT 55700 · lowest of 4 lines

$148
cash
—
cash
Prothrombin time (blood clotting test)

CPT 85610 · lowest of 10 lines

$16
cash
Psychotherapy, 30 minutes

CPT 90832 · lowest of 4 lines

$114
cash
Psychotherapy, 45 minutes

CPT 90834 · lowest of 2 lines

$174
cash
Psychotherapy, 60 minutes

CPT 90837 · lowest of 2 lines

$281
cash
Removal of a breast lump (biopsy by excision)

CPT 19120 · lowest of 2 lines

$402
cash
Screening mammogram (both breasts)

CPT 77067 · lowest of 4 lines

$119
cash
Shoulder arthroscopy with decompression

CPT 29826 · lowest of 2 lines

$526
cash
Sleep study (overnight, attended)

CPT 95810 · lowest of 4 lines

$1,539
cash
—
cash
$91
cash
TSH test (thyroid)

CPT 84443 · lowest of 4 lines

$53
cash
—
cash
Transvaginal ultrasound

CPT 76830 · lowest of 2 lines

$188
cash
Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines

$265
cash
Upper endoscopy (EGD)

CPT 43235 · lowest of 2 lines

$214
cash
Upper endoscopy with biopsy

CPT 43239 · lowest of 2 lines

$332
cash
—
cash
Vaginal delivery after a previous cesarean

CPT 59610 · lowest of 2 lines

$1,717
cash
$3,619
cash
X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines

$187
cash

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.