Maine / Mainehealth Pen Bay Hospital
CMS certification 200063 · Rockport, ME
Mainehealth Pen Bay Hospital: charges and Medicare payments
Mainehealth Pen Bay Hospital reported 299 Medicare inpatient stays across 15 DRGs in 2024. Across them it charged 2.63 times what it was paid — among the lower ratios in Maine, number 12 of 13 hospitals with at least 100 stays (state median 3.18×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 61 stays at an average charge of $47,548, 47% below the national average. It also billed 888 outpatient services, charging 5.36 times what Medicare paid.
- 1Medicare inpatient stays 299
- 2Charge ÷ paid, inpatient 2.63×
- 3Rank in ME (highest ratio = 1) 12 of 13
- 4CMS price-transparency actions 0
Inpatient stays
For the 15 DRGs that can be compared with the national average, Mainehealth Pen Bay Hospital charged more than the national average in 1 (7%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 61 | $47,548 | -47% | $24,788 |
| 291 Heart Failure and Shock with MCC | 39 | $36,042 | -36% | $12,608 |
| 885 Psychoses | 32 | $59,594 | +35% | $17,479 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 23 | $23,337 | -52% | $10,649 |
| 189 Pulmonary Edema and Respiratory Failure | 18 | $30,979 | -46% | $12,062 |
| 177 Respiratory Infections and Inflammations with MCC | 16 | $50,094 | -29% | $16,312 |
| 193 Simple Pneumonia and Pleurisy with MCC | 13 | $26,981 | -55% | $12,978 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 13 | $25,228 | -37% | $7,712 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 13 | $83,772 | -34% | $24,793 |
| 897 Alcohol, Drug Abuse or Dependence without Rehabilitation... | 13 | $26,215 | -29% | $8,463 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 12 | $24,990 | -31% | $7,293 |
| 310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC | 12 | $19,732 | -31% | $6,531 |
| 378 Gastrointestinal Hemorrhage with CC | 12 | $25,017 | -48% | $9,664 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 11 | $29,005 | -43% | $8,946 |
| 481 Hip and Femur Procedures except Major Joint with CC | 11 | $61,951 | -39% | $20,342 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 2 Urology and Related Services | 173 | $1,087 | $628 |
| Comprehensive Observation Services | 94 | $15,118 | $2,494 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 84 | $4,449 | $1,490 |
| Level 1 Intraocular Procedures | 78 | $11,796 | $2,142 |
| Level 3 Urology and Related Services | 74 | $5,783 | $1,872 |
| Level 5 Musculoskeletal Procedures | 68 | $49,512 | $12,078 |
| Level 2 Upper GI Procedures | 57 | $5,497 | $1,724 |
| Level 4 Urology and Related Services | 54 | $13,005 | $3,156 |
| Level 1 Laparoscopy and Related Services | 29 | $26,786 | $5,303 |
| Level 1 Nerve Procedures | 28 | $8,536 | $1,774 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 27 | $11,550 | $2,611 |
| Level 5 Urology and Related Services | 27 | $21,579 | $4,755 |
| Level 3 Vascular Procedures | 22 | $12,994 | $2,929 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 21 | $20,010 | $3,179 |
| Level 4 Musculoskeletal Procedures | 19 | $32,660 | $6,574 |
| Level 4 Gynecologic Procedures | 17 | $17,545 | $2,873 |
| Level 2 Musculoskeletal Procedures | 16 | $6,498 | $1,404 |
Against the Maine average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Mainehealth Pen Bay Hospital charged $47,548 on average, 18% less than the Maine average of $57,965, and was paid $24,788 against a state average of $19,002. For Heart Failure and Shock with MCC (DRG 291), Mainehealth Pen Bay Hospital charged $36,042 on average, 11% less than the Maine average of $40,287, and was paid $12,608 against a state average of $11,946. For Psychoses (DRG 885), Mainehealth Pen Bay Hospital charged $59,594 on average, 14% less than the Maine average of $69,033, and was paid $17,479 against a state average of $15,824. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), Mainehealth Pen Bay Hospital charged $23,337 on average, 26% less than the Maine average of $31,445, and was paid $10,649 against a state average of $10,386. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $1,087 was 23% below the state average of $1,404. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $15,118 was 14% above the state average of $13,250. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $4,449 was 42% below the state average of $7,697. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $11,796 was 13% above the state average of $10,436.
Price-transparency record
No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.