Maine / Southern Maine Health Care
CMS certification 200019 · Biddeford, ME
Southern Maine Health Care: charges and Medicare payments
Southern Maine Health Care reported 310 Medicare inpatient stays across 15 DRGs in 2024. Across them it charged 3.45 times what it was paid — mid-range in Maine, number 5 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: 64 stays at an average charge of $47,709, 47% below the national average. It also billed 484 outpatient services, charging 6.12 times what Medicare paid.
- 1Medicare inpatient stays 310
- 2Charge ÷ paid, inpatient 3.45×
- 3Rank in ME (highest ratio = 1) 5 of 13
- 4CMS price-transparency actions 0
Inpatient stays
For the 15 DRGs that can be compared with the national average, Southern Maine Health Care charged more than the national average in 0 (0%). 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 | 64 | $47,709 | -47% | $14,106 |
| 291 Heart Failure and Shock with MCC | 49 | $37,411 | -34% | $10,262 |
| 177 Respiratory Infections and Inflammations with MCC | 29 | $49,679 | -30% | $12,604 |
| 189 Pulmonary Edema and Respiratory Failure | 21 | $39,949 | -31% | $17,287 |
| 193 Simple Pneumonia and Pleurisy with MCC | 21 | $44,278 | -26% | $12,658 |
| 690 Kidney and Urinary Tract Infections without MCC | 19 | $23,144 | -39% | $6,663 |
| 682 Renal Failure with MCC | 15 | $40,219 | -39% | $11,513 |
| 312 Syncope and Collapse | 12 | $28,615 | -37% | $7,148 |
| 378 Gastrointestinal Hemorrhage with CC | 12 | $29,422 | -39% | $8,612 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 12 | $27,910 | -31% | $6,614 |
| 683 Renal Failure with CC | 12 | $22,484 | -45% | $7,193 |
| 178 Respiratory Infections and Inflammations with CC | 11 | $37,263 | -18% | $7,890 |
| 194 Simple Pneumonia and Pleurisy with CC | 11 | $26,288 | -32% | $8,662 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 11 | $25,177 | -30% | $6,323 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 11 | $21,018 | -43% | $6,469 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 64 | $13,512 | $2,476 |
| Level 1 Nerve Procedures | 62 | $10,532 | $1,791 |
| Level 5 Musculoskeletal Procedures | 54 | $48,070 | $12,348 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 43 | $6,681 | $1,523 |
| Level 3 Musculoskeletal Procedures | 36 | $18,643 | $2,907 |
| Level 5 Urology and Related Services | 34 | $26,043 | $4,748 |
| Level 4 Musculoskeletal Procedures | 29 | $33,849 | $6,168 |
| Level 1 Laparoscopy and Related Services | 27 | $36,082 | $5,421 |
| Level 4 Urology and Related Services | 26 | $18,747 | $3,276 |
| Level 1 Endovascular Procedures | 24 | $10,737 | $2,883 |
| Level 3 Vascular Procedures | 17 | $11,580 | $2,855 |
| Level 2 Upper GI Procedures | 17 | $8,053 | $1,704 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 14 | $15,466 | $2,670 |
| Level 2 Musculoskeletal Procedures | 14 | $6,898 | $1,510 |
| Level 3 Urology and Related Services | 12 | $15,097 | $1,787 |
| Level 3 Lower GI Procedures | 11 | $11,745 | $2,433 |
Against the Maine average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Southern Maine Health Care charged $47,709 on average, 18% less than the Maine average of $57,965, and was paid $14,106 against a state average of $19,002. For Heart Failure and Shock with MCC (DRG 291), Southern Maine Health Care charged $37,411 on average, 7% less than the Maine average of $40,287, and was paid $10,262 against a state average of $11,946. For Respiratory Infections and Inflammations with MCC (DRG 177), Southern Maine Health Care charged $49,679 on average, 6% less than the Maine average of $53,088, and was paid $12,604 against a state average of $15,399. For Pulmonary Edema and Respiratory Failure (DRG 189), Southern Maine Health Care charged $39,949 on average, 11% less than the Maine average of $45,067, and was paid $17,287 against a state average of $14,390. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $13,512 was 2% above the state average of $13,250. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $10,532 was 44% above the state average of $7,302. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $48,070 was 9% below the state average of $52,811. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $6,681 was 13% below the state average of $7,697.
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.