MaineHealth - Memorial Hospital
3073 White Mountain Highway, North Conway, NH · MaineHealth · · NPI 1760436216
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 |
|---|---|---|---|---|
| Special casting material HCPCS A4590 | not published | not published | $46.09 – $52.86 | 2 |
| Special physics consult CPT 77370 | $991.85 | $991.85 | $128.50 – $833.15 | 9 |
| Special pump services CPT 99190 | not published | not published | $552.90 – $866.90 | 4 |
| Special pump services CPT 99191 | not published | not published | $386.58 – $607.99 | 4 |
| Special pump services CPT 99192 | not published | not published | $276.00 – $433.80 | 4 |
| Special radiation dosimetry CPT 77331 | $861.30 | $861.30 | $18.87 – $723.49 | 9 |
| Special radiation treatment CPT 77470 | $2,618.55 | $2,618.55 | $38.07 – $2,199.58 | 9 |
| Special teletx port plan CPT 77321 | $842.65 | $842.65 | $44.08 – $707.83 | 9 |
| Specific gravity body fluid CPT 84315 | $48.95 | $48.95 | $1.31 – $12.27 | 9 |
| Specimen fat stain CPT 89125 | not published | not published | $2.35 – $11.97 | 7 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $680.25 | $680.25 | $223.55 – $416.84 | 9 |
| Speech audiometry complete CPT 92556 | not published | not published | $39.64 – $91.51 | 8 |
| Speech evaluation complex CPT 70371 | $756.60 | $756.60 | $40.25 – $635.54 | 9 |
| Speech recep thresh CPT 92555 | not published | not published | $25.56 – $58.97 | 8 |
| Speech Therapy Session (one-on-one) CPT 92507 | $329.75 | $329.75 | $75.09 – $216.76 | 9 |
| Sperm antibody test CPT 89325 | not published | not published | $5.27 – $21.73 | 7 |
| Sperm evaluation test CPT 89329 | not published | not published | $9.67 – $39.89 | 7 |
| Sperm identification CPT 89257 | not published | not published | $51.71 – $53.26 | 5 |
| Sperm isolation complex CPT 89261 | not published | not published | $14.88 – $53.26 | 6 |
| Sperm isolation simple CPT 89260 | not published | not published | $14.88 – $53.26 | 6 |
| Sperm washing 58323 CPT 58323 | not published | not published | $11.23 – $28.91 | 9 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $665.44 – $1,408.47 | 8 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $710.53 – $1,524.38 | 8 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | $101.39 – $223.68 | 8 |
| Spinal bone autograftlocal 20936 CPT 20936 | not published | not published | $162.10 – $253.51 | 4 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,292.65 | $1,292.65 | $80.30 – $426.60 | 9 |
| Spine device implant surgery HCPCS C9757 | not published | not published | $12,453.02 – $12,826.61 | 5 |
| Spine X-ray (single view, one level) CPT 72020 | $365.75 | $365.75 | $7.35 – $186.21 | 9 |
| Spirmtry w/brnchdil inf-2 yr CPT 94012 | not published | not published | $130.15 – $276.53 | 8 |
| Spirometry up to 2 yrs old CPT 94011 | not published | not published | $79.99 – $170.12 | 8 |
| Spleen imaging CPT 78185 | $654.25 | $654.25 | $15.44 – $549.57 | 9 |
| Splenectomy total open 38100 CPT 38100 | not published | not published | $1,072.68 – $2,335.01 | 8 |
| Splice spleen/kidney veins CPT 37181 | not published | not published | $2,145.79 – $4,697.15 | 8 |
| Splicing of ureters CPT 50770 | not published | not published | $1,091.30 – $2,323.51 | 8 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $641.65 | $641.65 | $216.94 – $599.77 | 9 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $156.85 | $156.85 | $45.45 – $147.44 | 9 |
| Splint finger 4 prong foam sm HCPCS A4570 | not published | not published | $12.69 – $23.72 | 3 |
| Splint finger fold over sm HCPCS L3924 | not published | not published | $100.99 – $254.24 | 7 |
| Splint finger frog med HCPCS L3927 | $89.50 | $89.50 | $29.54 – $84.13 | 9 |
| Splint fing stax assort 1-7in HCPCS Q4049 | not published | not published | $2.09 – $5.23 | 7 |
| Splint func pos polyflex ii med HCPCS L3999 | $118.70 | $118.70 | $74.19 – $94.80 | 6 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $221.80 | $221.80 | $19.47 – $53.82 | 9 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $9,427.65 | $9,427.65 | $660.67 – $1,635.71 | 9 |
| Split blood or products CPT 86985 | $410.50 | $410.50 | $10.80 – $199.42 | 9 |
| Split flat caliper stirr & p HCPCS L2230 | not published | not published | $68.29 – $171.90 | 7 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | not published | not published | $123.03 – $398.33 | 9 |
| Spontaneous nystagmus study CPT 92531 | not published | not published | $16.74 – $31.17 | 4 |
| Sprchoroidal spc njx rx agt CPT 67516 | not published | not published | $92.51 – $230.01 | 8 |
| Spring-ass rot wrst with latch HCPCS L6623 | not published | not published | $668.75 – $1,683.49 | 7 |
| Sputum specimen collection CPT 89220 | not published | not published | $16.80 – $38.64 | 8 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $4,303.90 | $4,303.90 | $940.43 – $3,615.28 | 9 |
| Srs cranial lesion complex CPT 61798 | not published | not published | $1,285.21 – $2,853.53 | 8 |
| Srs cranial lesion simple CPT 61796 | not published | not published | $955.63 – $2,111.36 | 8 |
| Srs cran les complex addl CPT 61799 | not published | not published | $274.10 – $618.15 | 8 |
| Srs cran les simple addl CPT 61797 | not published | not published | $198.56 – $447.35 | 8 |
| Srsf2 gene common variants CPT 81348 | not published | not published | $70.16 – $357.15 | 7 |
| Srs linear based CPT 77372 | $9,701.35 | $9,701.35 | $903.61 – $8,149.13 | 9 |
| Srs multisource CPT 77371 | not published | not published | $1,143.18 – $2,184.47 | 8 |
| Srs spinal lesion CPT 63620 | not published | not published | $1,053.29 – $2,333.00 | 8 |
| Srs spinal lesion addl CPT 63621 | not published | not published | $228.35 – $513.77 | 8 |
| Staggered spondaic word test CPT 92572 | not published | not published | $44.02 – $108.45 | 8 |
| Staging lapro hodgkins disease/lymphoma 49220 CPT 49220 | not published | not published | $1,980.43 – $1,980.43 | 1 |
| Stainless steel any wrist HCPCS L6630 | not published | not published | $272.44 – $685.83 | 7 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $680.25 | $680.25 | $106.70 – $223.00 | 9 |
| Stance phase only HCPCS L5858 | not published | not published | $17,297.78 – $43,544.65 | 7 |
| Standard control cable extra HCPCS L6655 | not published | not published | $77.94 – $196.19 | 7 |
| Staph a dna amp probe CPT 87640 | not published | not published | $17.33 – $71.45 | 7 |
| Static or dynami afo pre ots HCPCS L4397 | $83.80 | $83.80 | $61.64 – $212.34 | 9 |
| Stationary o2 contents, gas HCPCS E0441 | not published | not published | $64.43 – $127.36 | 6 |
| Stationary o2 contents, liq HCPCS E0442 | not published | not published | $64.43 – $127.36 | 6 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $478.85 | $478.85 | $99.59 – $219.37 | 9 |
| Stem cells total count CPT 86367 | not published | not published | $23.64 – $158.38 | 7 |
| Stenger test pure tone CPT 92565 | not published | not published | $18.68 – $42.70 | 8 |
| Stenger test speech CPT 92577 | not published | not published | $18.99 – $44.74 | 8 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $82,998.40 | $82,998.40 | $642.31 – $4,856.63 | 9 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $54,531.60 | $54,531.60 | $34.57 – $44.18 | 6 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $597.25 | $597.25 | $28.14 – $48.23 | 9 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $73,360.00 | $73,360.00 | $86.07 – $109.98 | 6 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $6,739.30 | $6,739.30 | $1,757.53 – $2,245.90 | 6 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $16,834.30 | $16,834.30 | $441.16 – $3,298.97 | 9 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $11,899.40 | $11,899.40 | $189.37 – $1,352.02 | 9 |
| Stent placemt retro carotid CPT 37217 | not published | not published | $976.17 – $2,140.49 | 8 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $29,817.20 | $29,817.20 | $623.84 – $16,808.18 | 9 |
| Stereoscopic x-ray guidance HCPCS G6002 | not published | not published | $19.91 – $41.36 | 8 |
| Stereotactic bx aspir/exc burr intracranial les 61750 CPT 61750 | not published | not published | $1,314.13 – $2,911.83 | 8 |
| Stereotactic radiation trmt CPT 77432 | not published | not published | $411.29 – $858.77 | 8 |
| Sterile gauze <= 16 sq in HCPCS A6402 | not published | not published | $0.12 – $0.31 | 7 |
| Sterile needle HCPCS A4215 | $293.60 | $293.60 | $0.20 – $177.90 | 9 |
| Sterile water/saline, 10 ml HCPCS A4216 | not published | not published | $0.49 – $1.24 | 7 |
| Sterile water/saline, 500 ml HCPCS A4217 | not published | not published | $2.95 – $7.80 | 7 |
| Sternal debridement CPT 21627 | not published | not published | $520.79 – $1,121.09 | 8 |
| Sternal pad HCPCS L1050 | not published | not published | $74.09 – $186.52 | 7 |
| St evaluate speech sound production CPT 92522 | $680.25 | $680.25 | $108.55 – $218.11 | 9 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $771.95 | $771.95 | $88.92 – $439.66 | 9 |
| Stimulants synthetic CPT 80371 | not published | not published | $5.62 – $50.16 | 4 |
| Stimulation of spinal cord CPT 63610 | not published | not published | $532.06 – $1,187.51 | 8 |
| Stocking sup grips 4 pre ots HCPCS L0982 | not published | not published | $19.32 – $48.64 | 7 |
| Stoma absorptive cover HCPCS A5083 | not published | not published | $0.72 – $1.79 | 7 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $2,713.45 | $2,713.45 | $35.24 – $952.10 | 9 |
| Storage/year embryo(s) CPT 89342 | not published | not published | $165.85 – $170.82 | 5 |
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.