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 |
|---|---|---|---|---|
| Swallowing Therapy Session CPT 92526 | $367.00 | $367.00 | $82.94 – $225.83 | 9 |
| Sweat collection by iontophoresis CPT 89230 | $276.75 | $276.75 | $2.14 – $232.47 | 9 |
| Symes ankle without (sach) foot HCPCS L5703 | not published | not published | $2,241.47 – $5,642.55 | 7 |
| Symes met fr leath socket ar HCPCS L5060 | not published | not published | $2,618.61 – $6,591.95 | 7 |
| Symes type medial opening so HCPCS L5636 | not published | not published | $322.10 – $810.81 | 7 |
| Symes type poster opening so HCPCS L5634 | not published | not published | $375.21 – $944.55 | 7 |
| Symes type ptb brim design s HCPCS L5632 | not published | not published | $239.92 – $604.00 | 7 |
| Syme typ expandabl wall sckt HCPCS L5630 | not published | not published | $484.52 – $1,219.70 | 7 |
| Sympathectomy cervical CPT 64802 | not published | not published | $800.17 – $1,761.60 | 8 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $737.30 – $1,574.53 | 8 |
| Sympathectomy lumbar CPT 64818 | not published | not published | $745.46 – $1,594.18 | 8 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $761.42 – $1,628.08 | 8 |
| Sympathectomy thoracolumbar CPT 64809 | not published | not published | $1,022.54 – $2,261.14 | 8 |
| Synch audio-only est high 40 CPT 98015 | $178.70 | $178.70 | $89.35 – $134.03 | 3 |
| Synch audio-only est low 20 CPT 98013 | $82.00 | $82.00 | $41.00 – $61.50 | 3 |
| Synch audio-only est mod 30 CPT 98014 | $120.85 | $120.85 | $60.43 – $90.64 | 3 |
| Synch audio-only est sf 10 CPT 98012 | $44.90 | $44.90 | $22.45 – $33.68 | 3 |
| Synch audio-only new high 60 CPT 98011 | $219.60 | $219.60 | $109.80 – $164.70 | 3 |
| Synch audio-only new low 30 CPT 98009 | $106.10 | $106.10 | $53.05 – $79.58 | 3 |
| Synch audio-only new mod 45 CPT 98010 | $166.70 | $166.70 | $83.35 – $125.03 | 3 |
| Synch audio-only new sf 15 CPT 98008 | $61.20 | $61.20 | $30.60 – $45.90 | 3 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $10.29 – $20.27 | 7 |
| Synthetic sentence id test CPT 92576 | not published | not published | $37.14 – $86.76 | 8 |
| Synvisc or synvisc-one HCPCS J7325 | $5,079.95 | $5,079.95 | $8.82 – $4,368.47 | 9 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $96.45 | $96.45 | $2.18 – $50.15 | 9 |
| System cardiomems hosp electronics HCPCS C2624 | $21,500.00 | $21,500.00 | $15,815.40 – $20,210.00 | 6 |
| System pacing micra av HCPCS C1786 | $12,650.00 | $12,650.00 | $1,061.38 – $1,356.31 | 6 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $4,910.00 | $4,910.00 | $1,900.79 – $2,428.96 | 6 |
| System recell skin grafting/harvesting HCPCS C1832 | $6,875.00 | $6,875.00 | $5,002.08 – $6,392.00 | 6 |
| T3 (triiodothyronine) free CPT 84481 | $431.00 | $431.00 | $8.37 – $149.51 | 9 |
| T3 (triiodothyronine) total CPT 84480 | $494.40 | $494.40 | $7.00 – $94.56 | 9 |
| T4 (thyroxine) free CPT 84439 | $387.20 | $387.20 | $5.11 – $77.97 | 9 |
| T4 (thyroxine) total CPT 84436 | $190.55 | $190.55 | $3.39 – $67.59 | 9 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $0.53 – $1.06 | 6 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $32.58 | $32.58 | $1.65 – $30.63 | 7 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $9.34 | $9.34 | $0.24 – $2.72 | 7 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | not published | not published | $238.60 – $477.88 | 8 |
| Tacrolimus therapeutic drug level CPT 80197 | $617.25 | $617.25 | $6.78 – $83.57 | 9 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | $5,107.06 | $5,107.06 | $13.41 – $4,800.64 | 9 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $2,050.07 – $4,421.28 | 8 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $1,895.09 – $4,085.78 | 8 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $1,166.77 – $2,520.75 | 8 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $607.60 | $607.60 | $8.00 – $256.73 | 9 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | not published | not published | $63.61 – $128.32 | 8 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | $15,169.70 | $15,169.70 | $72.40 – $4,256.77 | 9 |
| Talymed HCPCS Q4127 | not published | not published | $67.32 – $131.56 | 6 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | not published | not published | $0.29 – $3.38 | 3 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $70.80 – $665.59 | 9 |
| Tap block uni by cont infusion 64487 CPT 64487 | $1,626.10 | $1,626.10 | $56.23 – $410.53 | 9 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | not published | not published | $0.43 – $0.72 | 3 |
| Target gsa panel hmtlmph neop CPT 81450 | $6,125.50 | $6,125.50 | $303.81 – $1,273.75 | 9 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | not published | not published | $1,167.84 – $5,944.89 | 7 |
| Target gsa panel organ neop CPT 81445 | $4,768.95 | $4,768.95 | $239.16 – $2,006.29 | 9 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $19,167.08 | $19,167.08 | $1,567.49 – $4,901.71 | 9 |
| Tas congenital car anomal CPT 33741 | $35,777.80 | $35,777.80 | $678.53 – $30,053.35 | 9 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $124.20 – $428.52 | 9 |
| Tavr perq femoral CPT 33361 | $24,457.95 | $24,457.95 | $1,093.92 – $20,544.68 | 9 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $4,856.60 | $4,856.60 | $0.30 – $1,185.67 | 9 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $54.80 – $278.96 | 7 |
| Tbs dxa cal w/i&r fx risk CPT 77089 | not published | not published | $38.24 – $81.34 | 8 |
| Tbs i&r fx rsk qhp CPT 77092 | not published | not published | $9.30 – $19.65 | 8 |
| Tbs techl calculation only CPT 77091 | not published | not published | $26.18 – $55.57 | 8 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $2.42 – $5.42 | 8 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | not published | not published | $40.00 – $203.62 | 7 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $552.80 | $552.80 | $30.61 – $78.87 | 9 |
| Tc-99m apcitide diag HCPCS A9504 | not published | not published | $416.38 – $1,030.36 | 9 |
| Tc-99m arcitumomab HCPCS A9568 | not published | not published | $809.51 – $2,678.93 | 9 |
| Tc-99m bicisate HCPCS A9557 | $3,957.40 | $3,957.40 | $451.87 – $2,586.57 | 9 |
| Tc-99m depreotide HCPCS A9536 | not published | not published | $667.15 – $99,999.99 | 5 |
| Tc-99m diag per dose HCPCS A4641 | not published | not published | $99,999.99 – $99,999.99 | 1 |
| Tc-99m disofenin HCPCS A9510 | $129.15 | $129.15 | $42.50 – $86.54 | 9 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $4,307.70 | $4,307.70 | $1,040.32 – $3,107.73 | 9 |
| Tc-99m exametazime diag HCPCS A9521 | not published | not published | $698.76 – $1,748.25 | 9 |
| Tc-99m fanolesomab diag HCPCS A9566 | not published | not published | $99,999.99 – $99,999.99 | 1 |
| Tc-99m gluceptate HCPCS A9550 | not published | not published | $99,999.99 – $99,999.99 | 1 |
| Tc-99m graphite crucible HCPCS A9506 | not published | not published | $328.60 – $688.56 | 6 |
| Tc-99m labeled rbc HCPCS A9560 | $315.35 | $315.35 | $95.27 – $230.97 | 9 |
| Tc-99m maa HCPCS A9540 | $358.85 | $358.85 | $21.84 – $44.47 | 9 |
| Tc-99m mebrofenin HCPCS A9537 | $315.35 | $315.35 | $53.00 – $77.26 | 9 |
| Tc-99m medronate HCPCS A9503 | $315.35 | $315.35 | $13.26 – $107.31 | 9 |
| Tc-99m mertiatide HCPCS A9562 | $945.90 | $945.90 | $321.61 – $667.07 | 9 |
| Tc-99m non-heu per study dose HCPCS Q9969 | not published | not published | $0.13 – $20.36 | 7 |
| Tc-99m oxidronate HCPCS A9561 | $395.85 | $395.85 | $44.88 – $108.79 | 9 |
| Tc-99m pentetate dtpa HCPCS A9539 | $1,453.35 | $1,453.35 | $14.59 – $31.96 | 9 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $315.35 | $315.35 | $17.53 – $118.49 | 9 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $102.10 | $102.10 | $1.59 – $43.43 | 9 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $395.85 | $395.85 | $24.30 – $65.33 | 9 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $131.05 | $131.05 | $65.00 – $154.87 | 9 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $1,350.05 | $1,350.05 | $151.55 – $611.41 | 9 |
| Tc-99m sulfur colloid HCPCS A9541 | $449.95 | $449.95 | $81.28 – $104.59 | 9 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $304.90 | $304.90 | $86.98 – $125.26 | 9 |
| Tc-99m tilmanocept diag HCPCS A9520 | not published | not published | $674.81 – $99,999.99 | 5 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $392.35 – $1,031.80 | 9 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $56.03 – $118.62 | 8 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $55.61 – $117.26 | 8 |
| Tcd vasoreactivity study CPT 93890 | not published | not published | $49.23 – $101.67 | 7 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $77.17 – $435.81 | 7 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $216.05 | $216.05 | $23.20 – $88.08 | 9 |
| T cells absolute cd 4 count CPT 86361 | not published | not published | $13.22 – $54.53 | 7 |
| T cells total count CPT 86359 | $180.00 | $180.00 | $18.63 – $85.40 | 9 |
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.