Stephens Memorial Hospital
181 Main St, Norway, ME · MaineHealth · · NPI 1346299815
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 |
|---|---|---|---|---|
| Urinalysis glass test CPT 81020 | not published | not published | $4.70 – $9.85 | 7 |
| Urinalysis microscopic only CPT 81015 | $37.25 | $37.25 | $3.05 – $35.02 | 9 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.17 – $4.55 | 7 |
| Urinalysis (with microscopy) CPT 81001 | $129.10 | $129.10 | $3.17 – $121.35 | 9 |
| Urinalysis (without microscopy) CPT 81003 | $97.60 | $97.60 | $2.25 – $91.74 | 9 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $7.06 – $14.92 | 8 |
| Urinary pouch on barr w/flng HCPCS A5073 | not published | not published | $3.53 – $9.30 | 3 |
| Urinary pouch w/barrier HCPCS A5071 | not published | not published | $6.68 – $17.60 | 3 |
| Urinary reflex study CPT 51792 | not published | not published | $52.47 – $113.20 | 8 |
| Urinary suspensory HCPCS A5105 | not published | not published | $38.52 – $101.46 | 3 |
| Urine Culture Test CPT 87086 | $74.50 | $74.50 | $8.07 – $70.03 | 9 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $7.98 – $15.42 | 8 |
| Urine ost pouch w faucet/tap HCPCS A4428 | not published | not published | $7.24 – $19.09 | 3 |
| Urine pregnancy test CPT 81025 | $29.10 | $29.10 | $8.61 – $27.35 | 9 |
| Urine screen for bacteria CPT 81007 | not published | not published | $5.61 – $62.82 | 7 |
| Urine shunt to intestine CPT 50815 | not published | not published | $1,176.58 – $2,485.50 | 8 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $4.09 – $18.29 | 7 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $63.43 – $124.03 | 3 |
| Urography, antegrade CPT 74425 | $920.90 | $920.90 | $23.70 – $858.28 | 9 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $22.71 – $46.77 | 8 |
| Urokinase 250,000 iu inj HCPCS J3365 | not published | not published | $457.73 – $457.73 | 2 |
| Urokinase 5000 iu injection HCPCS J3364 | not published | not published | $9.16 – $9.16 | 2 |
| Use 1st target lesion CPT 76982 | not published | not published | $28.17 – $56.93 | 8 |
| User adjustable heel height HCPCS L5990 | not published | not published | $1,688.56 – $4,479.33 | 3 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | not published | not published | $12.50 – $25.23 | 8 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $35,748.44 | $35,748.44 | $153.96 – $33,603.53 | 9 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $59,196.40 – $59,196.40 | 1 |
| Vaccine Administration (one shot) CPT 90471 | $56.15 | $56.15 | $19.24 – $42.01 | 9 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $160.00 | $160.00 | $62.40 – $152.00 | 9 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $143.36 – $290.72 | 8 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $128.80 – $308.18 | 8 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $86.24 – $173.52 | 8 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $64.40 – $129.58 | 8 |
| Vaccine dtap < 7 years im CPT 90700 | not published | not published | $32.26 – $43.88 | 3 |
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $109.73 – $141.92 | 3 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $68.41 – $127.99 | 3 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $168.95 – $316.10 | 3 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $128.26 – $175.65 | 3 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $33.28 – $49.47 | 3 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | not published | not published | $13.50 – $46.10 | 3 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | not published | not published | $71.48 – $141.55 | 8 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | not published | not published | $141.34 – $192.27 | 3 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | not published | not published | $42.27 – $58.41 | 3 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $36.43 – $61.00 | 2 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $74.85 – $148.55 | 8 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | not published | not published | $71.79 – $139.12 | 8 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | not published | not published | $155.12 – $332.69 | 8 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | not published | not published | $30.37 – $60.83 | 8 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | not published | not published | $322.04 – $644.58 | 3 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | not published | not published | $179.39 – $254.00 | 3 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $425.09 | $425.09 | $71.34 – $399.58 | 9 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $58.62 – $165.04 | 3 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | not published | not published | $18.05 – $43.21 | 3 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $125.76 | $125.76 | $19.57 – $118.21 | 9 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | not published | not published | $20.65 – $38.64 | 8 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $73.11 – $142.45 | 8 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | not published | not published | $21.40 – $57.95 | 5 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | not published | not published | $21.95 – $41.34 | 8 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $10.33 – $19.32 | 8 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | not published | not published | $27.42 – $51.34 | 8 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | not published | not published | $71.34 – $135.18 | 8 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | not published | not published | $22.04 – $72.84 | 3 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $5.99 – $21.60 | 3 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | not published | not published | $250.60 – $468.85 | 3 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | not published | not published | $213.09 – $398.68 | 3 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | not published | not published | $187.02 – $349.90 | 3 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | not published | not published | $176.23 – $532.07 | 3 |
| Vaccine mmr live subcutaneous CPT 90707 | $551.63 | $551.63 | $86.75 – $518.53 | 9 |
| Vaccine mmrv live subcutaneous CPT 90710 | not published | not published | $302.57 – $562.58 | 4 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | not published | not published | $131.13 – $263.86 | 8 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | not published | not published | $253.60 – $510.01 | 8 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | not published | not published | $249.26 – $501.25 | 8 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $1,276.35 | $1,276.35 | $292.95 – $1,199.77 | 9 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | not published | not published | $47.76 – $64.31 | 3 |
| Vaccine rabies im CPT 90675 | not published | not published | $335.12 – $647.95 | 8 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | not published | not published | $330.40 – $618.15 | 3 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | not published | not published | $582.12 – $1,089.10 | 3 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | not published | not published | $582.12 – $1,089.10 | 3 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | not published | not published | $313.60 – $616.06 | 3 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | not published | not published | $130.82 – $213.62 | 3 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | not published | not published | $107.48 – $152.10 | 3 |
| Vaccine tdap >=7 years im CPT 90715 | $285.08 | $285.08 | $38.38 – $267.98 | 9 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $233.55 | $233.55 | $29.22 – $219.54 | 9 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $94.90 – $156.34 | 3 |
| Vaccine varicella live subcutaneous CPT 90716 | $824.74 | $824.74 | $127.42 – $775.26 | 9 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $147.77 – $230.13 | 3 |
| Vaccinia vrs vac 0.3 ml perq CPT 90622 | not published | not published | $0.02 – $0.03 | 2 |
| Vacuum drain bottle/tube kit HCPCS A7048 | not published | not published | $45.91 – $120.93 | 3 |
| Vad battery clip set hmii 14-v li-ion HCPCS Q0497 | not published | not published | $438.84 – $1,155.86 | 3 |
| Vad cable power module dc input HCPCS Q0478 | not published | not published | $172.27 – $453.75 | 3 |
| Vad univ batt charger hm 1440 HCPCS Q0495 | not published | not published | $3,915.54 – $10,313.17 | 3 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $965.11 – $2,030.02 | 8 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $1,207.50 – $2,530.91 | 8 |
| Vag hyst including t/o CPT 58262 | not published | not published | $899.71 – $1,892.41 | 8 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $1,272.67 – $2,665.79 | 8 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $1,181.81 – $2,477.35 | 8 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $869.13 – $1,824.64 | 8 |
| Vaginal bx CPT 58999 | not published | not published | $925.54 – $925.54 | 1 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $858.95 – $1,842.94 | 8 |
| Vaginal Delivery (full care) CPT 59400 | not published | not published | $2,282.40 – $4,935.74 | 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.