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 |
|---|---|---|---|---|
| Gi inhouse confirmation CPT 87045 | $222.70 | $222.70 | $9.44 – $209.78 | 9 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $290.03 – $912.94 | 9 |
| Gi protein loss CPT 78282 | not published | not published | $15.24 – $30.51 | 8 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $109.66 – $223.67 | 8 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $118.26 – $241.29 | 8 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $44.21 – $90.15 | 8 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $103.16 – $210.11 | 8 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $211.89 | 7 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $128.79 | 7 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $73.19 | 7 |
| Glassia injection HCPCS J0257 | not published | not published | $5.25 – $10.90 | 8 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $60.42 – $128.09 | 8 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $39.58 – $84.05 | 8 |
| Glaucoma surgery CPT 66150 | not published | not published | $836.18 – $1,763.64 | 8 |
| Glaucoma surgery CPT 66155 | not published | not published | $835.51 – $1,762.28 | 8 |
| Glaucoma surgery CPT 66160 | not published | not published | $940.76 – $1,980.52 | 8 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,042.79 – $2,199.45 | 8 |
| Glove finger flexion right lg xl HCPCS L3912 | not published | not published | $82.58 – $219.08 | 3 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $188.37 – $364.08 | 8 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $1,045.19 | $1,045.19 | $112.98 – $982.48 | 9 |
| Glucagon plasma - sendout CPT 82943 | $123.60 | $123.60 | $14.29 – $116.43 | 9 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $96.24 | 7 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $105.74 | 7 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.77 – $37.24 | 7 |
| Glucose 1 hr post dose CPT 82950 | $36.50 | $36.50 | $4.75 – $34.38 | 9 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $12.68 | 7 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $7.00 | $7.00 | $2.66 – $6.77 | 9 |
| Glucose blood quantitative CPT 82947 | $102.90 | $102.90 | $3.18 – $14.25 | 9 |
| Glucose body fluid CPT 82945 | $29.50 | $29.50 | $3.93 – $27.79 | 9 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $56.58 – $134.21 | 8 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $172.70 | $172.70 | $12.87 – $162.68 | 9 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $63.45 | $63.45 | $3.92 – $59.77 | 9 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $49.94 | $49.94 | $0.62 – $47.04 | 9 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $27.79 – $30.15 | 3 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $8,706.29 | $8,706.29 | $11.37 – $8,183.91 | 9 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $171.40 | $171.40 | $18.58 – $161.46 | 9 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $310.98 | 7 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $319.65 | $319.65 | $18.52 – $301.11 | 9 |
| Gonioscopy CPT 92020 | not published | not published | $19.90 – $52.69 | 9 |
| Goniotomy CPT 65820 | not published | not published | $786.95 – $1,647.05 | 8 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $572.82 – $1,389.82 | 8 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $79.64 | $79.64 | $30.40 – $74.86 | 9 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $1,309.05 – $2,292.36 | 8 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $149.15 – $174.25 | 3 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $889.70 – $1,887.67 | 8 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $1,950.00 | $1,950.00 | $31.11 – $414.08 | 9 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $762.88 – $2,304.98 | 3 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $4,675.00 | $4,675.00 | $491.00 – $1,151.41 | 9 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $577.00 | $577.00 | $231.78 – $543.53 | 9 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $7,578.00 | $7,578.00 | $39.06 – $7,123.32 | 9 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $534.83 | $534.83 | $77.97 – $182.68 | 9 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $1,029.56 – $2,249.62 | 8 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $135.45 – $274.29 | 8 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | not published | not published | $45.00 – $95.78 | 8 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $162.08 – $320.39 | 3 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $20,691.00 | $20,691.00 | $476.82 – $1,118.15 | 9 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $97.32 – $270.52 | 8 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $2,437.82 | $2,437.82 | $16.27 – $38.15 | 9 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $7,748.80 | $7,748.80 | $169.00 – $396.30 | 9 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $1.46 – $77.95 | 3 |
| Granisetron hcl injection HCPCS J1626 | $133.55 | $133.55 | $0.30 – $125.54 | 9 |
| Granulocyte pheresis ea unit HCPCS P9050 | not published | not published | $1,345.16 – $1,345.16 | 1 |
| Great toe-hand transfer CPT 26551 | not published | not published | $3,158.24 – $6,719.70 | 8 |
| Great toe with reduction 28495 CPT 28495 | $332.00 | $332.00 | $144.62 – $357.21 | 9 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $481.01 – $1,155.15 | 9 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $486.51 – $1,184.06 | 9 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $141.98 – $369.42 | 9 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $461.01 – $988.92 | 8 |
| Ground mileage HCPCS A0425 | $16.00 | $16.00 | $5.55 – $19.17 | 5 |
| Group behave couns 2-10 HCPCS G0473 | not published | not published | $11.30 – $23.78 | 8 |
| Group health education CPT 99078 | not published | not published | $61.04 – $61.04 | 1 |
| Group mnt 2 or more 30 mins HCPCS G0271 | not published | not published | $15.13 – $32.13 | 8 |
| Group train without patient HCPCS G0543 | not published | not published | $21.69 – $21.69 | 1 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.74 – $32.98 | 7 |
| Growth hormone panel CPT 80428 | not published | not published | $66.70 – $139.62 | 7 |
| Growth hormone panel CPT 80430 | not published | not published | $129.33 – $271.00 | 7 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $45.02 – $158.41 | 7 |
| Grp adapt bhv tx by phy/qhp CPT 97158 | not published | not published | $8.44 – $40.64 | 3 |
| Grp adapt bhv tx by tech CPT 97154 | not published | not published | $4.23 – $21.64 | 3 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $1,829.94 – $3,925.82 | 8 |
| Gstr rstcv oth/thn v-band CPT 43843 | not published | not published | $1,223.60 – $2,629.86 | 8 |
| Gstr rstcv px shrt roux-en-y CPT 43846 | not published | not published | $1,573.33 – $3,378.83 | 8 |
| Gstr rstcv px sm int rcnstj CPT 43847 | not published | not published | $1,721.67 – $3,695.36 | 8 |
| Gstr rstcv px v-banded gstp CPT 43842 | not published | not published | $1,123.03 – $2,344.52 | 7 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $672.04 – $1,443.04 | 8 |
| G-tube reposition CPT 43761 | $276.70 | $276.70 | $100.18 – $231.90 | 9 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $38.66 – $78.62 | 8 |
| Guided cath fluid drainage 10030 CPT 10030 | $917.80 | $917.80 | $130.99 – $864.57 | 9 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | not published | not published | $527.76 – $1,400.02 | 3 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $76.00 | $76.00 | $3.53 – $8.29 | 9 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $73.00 | $73.00 | $29.32 – $68.77 | 9 |
| Guid loc target vol rad tx CPT 77387 | not published | not published | $53.54 – $246.70 | 3 |
| Gum graft CPT 41870 | not published | not published | $594.28 – $626.98 | 3 |
| Gw stiffened micro access kit HCPCS C1894 | $896.00 | $896.00 | $7.24 – $16.98 | 9 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $414.46 – $1,118.53 | 9 |
| Hair analysis HCPCS P2031 | not published | not published | $4.95 – $10.16 | 7 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $150.88 – $161.31 | 3 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $244.08 – $725.99 | 9 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $333.94 – $981.69 | 9 |
| Hallus-valgus nt dyn pre ots HCPCS L3100 | not published | not published | $40.17 – $106.53 | 3 |
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.