Waldo County General Hospital
118 Northport Ave, Belfast, ME · MaineHealth · · NPI 1841397932
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 |
|---|---|---|---|---|
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $3,630.70 | $3,630.70 | $85.49 – $3,420.12 | 9 |
| CT Angiogram of the Head CPT 70496 | $3,038.15 | $3,038.15 | $82.45 – $2,861.94 | 9 |
| CT Angiogram of the Neck CPT 70498 | $3,542.95 | $3,542.95 | $82.45 – $3,337.46 | 9 |
| CT angio hrt w/3d image CPT 75574 | $2,214.85 | $2,214.85 | $112.02 – $2,086.39 | 9 |
| CT angio pelvis CPT 72191 | $2,765.50 | $2,765.50 | $84.21 – $2,605.10 | 9 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $2,490.20 | $2,490.20 | $84.21 – $2,345.77 | 9 |
| CT bone density axial CPT 77078 | not published | not published | $11.68 – $23.72 | 8 |
| CT colonography dx CPT 74261 | $1,446.85 | $1,446.85 | $112.87 – $1,362.93 | 9 |
| CT colonography dx w/dye CPT 74262 | $1,587.20 | $1,587.20 | $117.58 – $1,495.14 | 9 |
| CT colonography screening CPT 74263 | $1,446.85 | $1,446.85 | $107.23 – $1,362.93 | 9 |
| CT guidance for needle placement CPT 77012 | $1,861.20 | $1,861.20 | $69.12 – $1,753.25 | 9 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $2,523.85 | $2,523.85 | $54.51 – $217.50 | 9 |
| CT guid cryo ablat intramuscular CPT 20999 | $882.70 | $882.70 | $271.63 – $636.37 | 9 |
| CT guid parench tis ablat CPT 77013 | not published | not published | $179.83 – $367.37 | 8 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $1,297.05 | $1,297.05 | $27.52 – $1,221.82 | 9 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $2,214.85 | $2,214.85 | $118.99 – $2,086.39 | 9 |
| CT hrt w/3d image CPT 75572 | $2,214.85 | $2,214.85 | $81.68 – $2,086.39 | 9 |
| CT limited or localized follow-up study CPT 76380 | $1,028.40 | $1,028.40 | $44.92 – $968.75 | 9 |
| Ctlso a-p-l control molded HCPCS L0700 | not published | not published | $1,998.85 – $5,302.46 | 3 |
| Ctlso a-p-l control with inter HCPCS L0710 | not published | not published | $2,156.60 – $5,720.96 | 3 |
| Ctlso axilla sling HCPCS L1010 | not published | not published | $65.91 – $174.89 | 3 |
| Ctlso milwauke initial model HCPCS L1000 | not published | not published | $2,279.70 – $6,047.49 | 3 |
| CT lwr extremity w/o&w/dye CPT 73702 | $2,812.75 | $2,812.75 | $56.97 – $2,649.61 | 9 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $641.10 | $641.10 | $128.90 – $724.70 | 9 |
| CT scan for localization CPT 77011 | not published | not published | $60.52 – $124.03 | 8 |
| CT scan for therapy guide CPT 77014 | not published | not published | $44.04 – $92.18 | 8 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $6,057.45 | $6,057.45 | $94.25 – $5,706.12 | 9 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $4,781.90 | $4,781.90 | $85.80 – $4,504.55 | 9 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $3,659.00 | $3,659.00 | $82.10 – $3,446.78 | 9 |
| CT t-spine w /wo contrast CPT 72130 | $2,812.75 | $2,812.75 | $59.86 – $2,649.61 | 9 |
| CT uppr extremity w/o&w/dye CPT 73202 | $2,812.75 | $2,812.75 | $57.28 – $2,649.61 | 9 |
| Cuffs adj lock with active con HCPCS L3740 | not published | not published | $1,240.90 – $3,291.82 | 3 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $841.96 – $2,271.98 | 3 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $841.96 – $2,362.81 | 3 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $699.08 – $1,533.56 | 9 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $608.52 – $1,363.96 | 9 |
| Culture aerobic additional method definitive id each CPT 87077 | $32.85 | $32.85 | $8.08 – $30.94 | 9 |
| Culture afb any source CPT 87116 | $102.60 | $102.60 | $10.80 – $96.65 | 9 |
| Culture anaerobic additional method definitive id each CPT 87076 | $159.95 | $159.95 | $8.08 – $150.67 | 9 |
| Culture anaerobic except blood CPT 87075 | $226.75 | $226.75 | $9.47 – $213.60 | 9 |
| Culture bacteria anaerobic CPT 87073 | not published | not published | $9.66 – $20.24 | 7 |
| Culture bacterial urine HCPCS P7001 | not published | not published | $22.30 – $36.61 | 3 |
| Culture bact stool aero addl path ea CPT 87046 | $13.50 | $13.50 | $5.42 – $12.72 | 9 |
| Culture body fluid CPT 87070 | $181.60 | $181.60 | $8.62 – $171.07 | 9 |
| Culture fungi definitive id mold CPT 87107 | $17.05 | $17.05 | $6.85 – $16.06 | 9 |
| Culture fungi definitive id yeast CPT 87106 | $32.40 | $32.40 | $10.32 – $30.52 | 9 |
| Culture fungi other (except blood) CPT 87102 | $120.05 | $120.05 | $8.41 – $113.09 | 9 |
| Culture fungi skin/hair/nail CPT 87101 | $99.90 | $99.90 | $7.71 – $94.11 | 9 |
| Culture mycobacteria definitive id each isolate CPT 87118 | not published | not published | $14.61 – $30.51 | 7 |
| Culture mycoplasma any source CPT 87109 | not published | not published | $15.39 – $32.25 | 7 |
| Culture of specimen by kit CPT 87084 | not published | not published | $15.27 – $56.72 | 7 |
| Culture quantitative aerobic other source CPT 87071 | not published | not published | $9.89 – $20.72 | 7 |
| Culture screening strep group a CPT 87081 | $75.80 | $75.80 | $5.37 – $33.00 | 9 |
| Culture type pulse field gel CPT 87152 | not published | not published | $7.74 – $16.22 | 7 |
| Culture typing added method CPT 87158 | not published | not published | $7.74 – $16.22 | 7 |
| Culture typing glc/hplc CPT 87143 | not published | not published | $12.52 – $26.23 | 7 |
| Culture typing immunologic CPT 87147 | not published | not published | $5.18 – $10.85 | 7 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | not published | not published | $139.56 – $456.85 | 7 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | not published | not published | $35.09 – $73.19 | 7 |
| Culture urine each isolate CPT 87088 | not published | not published | $8.09 – $16.95 | 7 |
| Culture virus isolation CPT 87250 | not published | not published | $19.56 – $40.67 | 7 |
| Curette/treat cornea CPT 65435 | not published | not published | $65.91 – $158.04 | 9 |
| Curette/treat cornea CPT 65436 | not published | not published | $352.60 – $747.61 | 9 |
| Cus elbo skt in for con/atyp HCPCS L6696 | not published | not published | $1,224.27 – $3,247.72 | 3 |
| Cus elbo skt in not con/atyp HCPCS L6697 | not published | not published | $1,224.27 – $3,247.72 | 3 |
| Custom glove for term device HCPCS L6895 | not published | not published | $705.86 – $1,872.48 | 3 |
| Custom shape cover ak HCPCS L5705 | not published | not published | $1,032.71 – $2,739.51 | 3 |
| Custom shape cover bk HCPCS L5704 | not published | not published | $563.30 – $1,494.32 | 3 |
| Custom shape cvr hip disart HCPCS L5707 | not published | not published | $1,353.28 – $3,589.94 | 3 |
| Custom shape cvr knee disart HCPCS L5706 | not published | not published | $1,007.29 – $2,672.08 | 3 |
| Cv line/pic reposition CPT 36597 | not published | not published | $58.48 – $211.36 | 9 |
| Cv stress test i&r only 93018 CPT 93018 | not published | not published | $13.72 – $28.48 | 8 |
| Cv stress test/supervision only 93016 CPT 93016 | not published | not published | $20.79 – $42.01 | 8 |
| Cyanocobalamin unsat binding capacity CPT 82608 | not published | not published | $14.32 – $29.82 | 7 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $112.58 | $112.58 | $1.11 – $105.83 | 9 |
| Cyclic citrullinated peptide antibody CPT 86200 | $253.75 | $253.75 | $10.49 – $28.50 | 9 |
| Cyclophosphamide 100 mg inj HCPCS J9070 | not published | not published | $17.94 – $127.78 | 8 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | $6,379.93 | $6,379.93 | $1.74 – $2,003.32 | 9 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | not published | not published | $0.62 – $1.66 | 8 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | not published | not published | $39.89 – $141.06 | 4 |
| Cyclosporine 2 hour CPT 80158 | $203.85 | $203.85 | $18.05 – $192.03 | 9 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | not published | not published | $0.70 – $1.63 | 8 |
| Cyclosporine oral 100 mg HCPCS J7502 | not published | not published | $2.19 – $4.34 | 8 |
| Cygnus matrix, per sq cm HCPCS Q4199 | not published | not published | $273.20 – $719.15 | 8 |
| Cygnus, per sq cm HCPCS Q4170 | not published | not published | $45.56 – $276.53 | 8 |
| Cymetra injectable HCPCS Q4112 | not published | not published | $872.08 – $872.08 | 2 |
| Cyp2c19 gene com variants CPT 81225 | not published | not published | $251.45 – $610.53 | 7 |
| Cyp2c9 gene com variants CPT 81227 | not published | not published | $147.30 – $366.01 | 7 |
| Cyp2d6 gene com variants CPT 81226 | not published | not published | $260.60 – $944.85 | 7 |
| Cyp3a4 gene common variants CPT 81230 | not published | not published | $174.81 – $366.01 | 7 |
| Cyp3a5 gene common variants CPT 81231 | not published | not published | $174.81 – $366.01 | 7 |
| Cystatin c CPT 82610 | $107.45 | $107.45 | $18.52 – $101.22 | 9 |
| Cystic fibrosis cftr CPT 81223 | not published | not published | $499.00 – $1,045.62 | 7 |
| Cystine urine quantitative CPT 82131 | not published | not published | $22.98 – $48.13 | 7 |
| Cysto cgen post urtl valves CPT 52400 | not published | not published | $458.68 – $969.24 | 8 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $1,194.50 | $1,194.50 | $14.95 – $1,125.22 | 9 |
| Cysto impl 4 or more HCPCS C9740 | not published | not published | $45,433.58 – $45,433.58 | 1 |
| Cysto insj dev ischmc rmdlg CPT 53865 | not published | not published | $332.80 – $45,433.58 | 2 |
| Cysto, litho, vacuum kidney HCPCS C9761 | not published | not published | $45,433.58 – $45,433.58 | 1 |
| Cystometrogram w/up 51727 CPT 51727 | not published | not published | $102.29 – $212.14 | 8 |
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.