Northern Light A R Gould Hospital
Po Box 151, Presque Isle, ME 04769 · 136 Priced Procedures · 61% Patient Recommendation
Typical commercial prices here match the fair market benchmark (1.02×) after accounting for local nurse/doctor wages and patient complexity.
3-Star CMS clinical quality rating paired with 1.02× fair market pricing.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Northern Light A R Gould Hospital prices routine shoppable procedures near 1.2× Medicare (p50 0.97×) while skewing captive emergency, lab, and upper-quartile codes to 4.5× Medicare (p75 1.23×, +27% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.74× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 72% of shoppable procedures (99/100 Cash Honesty)
- 2-Star CMS clinical rating with 61% patient recommendation (62/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (37.4% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.02× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (0.6×) & laboratory (0.7×) services average 3.75× higher multiples than routine shoppable care (1.2×)
- Upper-quartile procedures (Q75 1.23×) jump +27% above the median procedure ratio (Q50 0.97×)
- Unnegotiated chargemaster list prices average 5.0× Medicare (23¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Northern Light A R Gould Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 136 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Vaginal delivery (full package) CPT Code: 59400 | $6,566 | unverified |
| C-section delivery (full package) CPT Code: 59510 | $5,076 | unverified |
| Total hip replacement CPT Code: 27130 | $1,791 | 0.1× |
| Blood transfusion CPT Code: 36430 | $1,177 | unverified |
| Bunion correction surgery CPT Code: 28296 | $1,085 | 0.3× |
| Breast lump removal CPT Code: 19120 | $865 | 0.2× |
| Cataract surgery with lens implant CPT Code: 66984 | $818 | 0.3× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $834 | 0.2× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $713 | 0.7× |
| Inguinal hernia repair CPT Code: 49505 | $714 | 0.2× |
| Trauma team activation HCPCS Code: G0390 | $674 | 0.5× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $637 | 0.6× |
| Colonoscopy with biopsy CPT Code: 45380 | $627 | 0.5× |
| Upper endoscopy with biopsy CPT Code: 43239 | $589 | 0.6× |
| Breathing treatment (nebulizer) CPT Code: 94640 | $590 | unverified |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $486 | 0.1× |
| Rabies immune globulin HCPCS Code: 90375 | $509 | unverified |
| MRI, brain (with and without contrast) CPT Code: 70553 | $339 | 0.7× |
| Injection procedure for pain management HCPCS Code: G0260 | $331 | 0.4× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $274 | unverified |
| Psychiatric evaluation (first visit) CPT Code: 90791 | $296 | unverified |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $286 | unverified |
| Neurobehavioral status check CPT Code: 96116 | $206 | 0.9× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $231 | 0.8× |
| MRI, lower back (no contrast) CPT Code: 72148 | $223 | 0.7× |
Audit a Bill or Quote at Northern Light A R Gould Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $4,294
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (37.4% of gross = $4,294).
Self-Pay Cash Rate ($2,413) Beats Your Bill
Northern Light A R Gould Hospital's published 45 CFR § 180 self-pay cash rate is $2,413 (vs. $6,566 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $2,680 Fair BaseRate ($2,214 Medicare)
Your bill ($11,491) is $8,811 above the denoised Fair BaseRate ($2,680) and 5.2× the $2,214 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (37.4% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)CMS Price Transparency Administrative Enforcement Log
Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Northern Light A R Gould Hospital. Prior administrative notices do not necessarily reflect current compliance status.
- 2023-06-15·administrative_or_closure
Closure Notice
Recorded - 2023-03-09·warning_notice
Warning Notice
Recorded
Source: CMS Hospital Care Compare (307 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Northern Light A R Gould Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.