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 |
|---|---|---|---|---|
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $169.87 – $450.84 | 8 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $263.59 – $775.73 | 8 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $240.55 – $650.20 | 8 |
| Tdh sdrl/ventr pnxr CPT 61105 | not published | not published | $440.01 – $968.58 | 8 |
| Teaec w/wo patch graft iliofemoral CPT 35355 | not published | not published | $922.93 – $2,040.86 | 8 |
| Team conf without pat by hc pro CPT 99368 | not published | not published | $34.55 – $73.18 | 6 |
| Team conf without pat by phys CPT 99367 | $405.05 | $405.05 | $53.05 – $115.84 | 8 |
| Team conf w/pat by hc prof CPT 99366 | $61.65 | $61.65 | $39.25 – $83.75 | 8 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | $24,813.33 | $24,813.33 | $202.84 – $23,324.53 | 9 |
| Tee w or without fol w/cont,cong HCPCS C8926 | $3,333.05 | $3,333.05 | $764.65 – $3,133.07 | 9 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $764.65 – $787.59 | 5 |
| Teflon or equal cable lining HCPCS L6665 | not published | not published | $53.10 – $133.66 | 7 |
| Telavancin injection HCPCS J3095 | not published | not published | $7.05 – $13.70 | 8 |
| Telehealth original site facility fee HCPCS Q3014 | $117.75 | $117.75 | $29.21 – $50.57 | 9 |
| Telethx isodose plan cplx CPT 77307 | $5,019.90 | $5,019.90 | $135.06 – $4,216.72 | 9 |
| Telethx isodose plan simple CPT 77306 | $2,241.70 | $2,241.70 | $71.55 – $1,883.03 | 9 |
| Temozolomide HCPCS J8700 | $244.33 | $244.33 | $0.20 – $13.82 | 7 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | $4,701.50 | $4,701.50 | $10.39 – $4,419.41 | 9 |
| Temperature gradient studies CPT 93740 | not published | not published | $2.70 – $155.97 | 7 |
| Temple bne implnt w/stimulat CPT 69715 | not published | not published | $2,782.74 – $2,782.74 | 1 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $9,862.28 | $9,862.28 | $30.75 – $9,270.54 | 9 |
| Tendon lengthening CPT 26476 | not published | not published | $622.46 – $1,321.03 | 8 |
| Tendon lngth upr a/e ea tdn CPT 24305 | not published | not published | $560.78 – $1,201.05 | 8 |
| Tendon shortening CPT 26477 | not published | not published | $606.11 – $1,291.21 | 8 |
| Tendon transfer with graft CPT 26492 | not published | not published | $893.75 – $1,906.66 | 8 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $23,594.09 | $23,594.09 | $146.56 – $22,178.44 | 9 |
| Teniposide, 50 mg HCPCS Q2017 | not published | not published | $346.95 – $4,091.09 | 4 |
| Tenodesis biceps tdn at elbw CPT 24340 | not published | not published | $581.25 – $1,235.63 | 8 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | $586.45 – $1,237.67 | 8 |
| Tenolysis triceps CPT 24332 | not published | not published | $594.70 – $1,276.29 | 8 |
| Tenoplasty elbow to sho 1 CPT 24320 | not published | not published | $752.17 – $1,607.07 | 8 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $500.33 – $1,072.28 | 8 |
| Tenotomy hip flexor open CPT 27005 | not published | not published | $690.46 – $1,483.03 | 8 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | $672.00 | $672.00 | $284.56 – $854.48 | 9 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $232.87 – $727.27 | 9 |
| Tension based scoliosis orth HCPCS L1005 | not published | not published | $2,973.14 – $7,484.46 | 7 |
| Tens suppl 2 lead per month HCPCS A4595 | not published | not published | $9.83 – $24.92 | 7 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $156.60 | $156.60 | $0.86 – $55.37 | 9 |
| Teriparatide injection HCPCS J3110 | not published | not published | $16.26 – $85.87 | 4 |
| Term dev auto grasp feature HCPCS L6881 | not published | not published | $3,805.05 – $9,578.67 | 7 |
| Term device, multi art digit HCPCS L6715 | not published | not published | $2,938.43 – $7,397.07 | 7 |
| Term dev mech hand vol close HCPCS L6709 | not published | not published | $1,148.64 – $2,891.51 | 7 |
| Term dev mech hand vol open HCPCS L6708 | not published | not published | $821.55 – $2,068.13 | 7 |
| Term dev mech hook vol close HCPCS L6707 | not published | not published | $1,365.75 – $3,438.10 | 7 |
| Term dev mech hook vol open HCPCS L6706 | not published | not published | $379.18 – $954.55 | 7 |
| Term dev modifier wrist unit HCPCS L6805 | not published | not published | $342.84 – $863.02 | 7 |
| Term dev, passive hand mitt HCPCS L6703 | not published | not published | $366.84 – $923.46 | 7 |
| Term dev precision pinch dev HCPCS L6810 | not published | not published | $177.03 – $445.64 | 7 |
| Term dev, sport/rec/work att HCPCS L6704 | not published | not published | $555.23 – $1,397.71 | 7 |
| Tert gene targeted seq alys CPT 81345 | not published | not published | $74.08 – $377.10 | 7 |
| Test for chlorohydrocarbons CPT 82441 | not published | not published | $2.97 – $12.24 | 7 |
| Test for porphobilinogen CPT 84106 | not published | not published | $2.33 – $11.85 | 7 |
| Test for urine cystines CPT 82615 | not published | not published | $4.03 – $19.45 | 7 |
| Testicular imaging w/vasc flow CPT 78761 | $879.80 | $879.80 | $32.33 – $739.03 | 9 |
| Testosterone pellet 75 mg HCPCS S0189 | not published | not published | $107.24 – $220.28 | 3 |
| Testosterone response panel CPT 80414 | not published | not published | $25.50 – $105.15 | 7 |
| Testosterone undecanoate 1mg HCPCS J3145 | not published | not published | $1.84 – $3.71 | 8 |
| Test pathogen(s) for platelets reference HCPCS P9100 | not published | not published | $57.49 – $59.21 | 5 |
| Test sock elbw disart/above HCPCS L6682 | not published | not published | $272.37 – $685.63 | 7 |
| Test socket above knee HCPCS L5624 | not published | not published | $459.57 – $1,156.91 | 7 |
| Test socket below knee HCPCS L5620 | not published | not published | $351.44 – $884.71 | 7 |
| Test socket hemipelvectomy HCPCS L5628 | not published | not published | $518.56 – $1,305.39 | 7 |
| Test socket hip disarticulat HCPCS L5626 | not published | not published | $547.30 – $1,377.75 | 7 |
| Test socket knee disarticula HCPCS L5622 | not published | not published | $428.42 – $1,078.49 | 7 |
| Test socket shldr disart/tho HCPCS L6684 | not published | not published | $407.33 – $1,025.39 | 7 |
| Test socket symes HCPCS L5618 | not published | not published | $355.52 – $894.95 | 7 |
| Test sock wrist disart/bel e HCPCS L6680 | not published | not published | $223.83 – $563.46 | 7 |
| Test stress cardiovascular tracing only CPT 93017 | $1,746.30 | $1,746.30 | $33.29 – $735.42 | 9 |
| Test urine for lactose CPT 83633 | not published | not published | $4.50 – $22.91 | 7 |
| Test urine for porphyrins CPT 84119 | not published | not published | $5.34 – $27.20 | 7 |
| Test urine urobilinogen CPT 84578 | not published | not published | $1.79 – $9.10 | 7 |
| Tetanus ig im CPT 90389 | not published | not published | $188.42 – $1,064.05 | 4 |
| Tetanus immune globulin inj HCPCS J1670 | $4,336.02 | $4,336.02 | $556.53 – $2,569.07 | 9 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $31,356.05 | $31,356.05 | $18.16 – $14,737.37 | 9 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $54.80 – $278.96 | 7 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $303.81 – $1,546.55 | 7 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $1,167.84 – $5,944.89 | 7 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $239.16 – $1,217.46 | 7 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $165.85 – $170.82 | 5 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $165.85 – $170.82 | 5 |
| Thawing cryopresrved oocyte CPT 89356 | not published | not published | $165.85 – $170.82 | 5 |
| Thawing cryopresrved sperm CPT 89353 | not published | not published | $51.71 – $53.26 | 5 |
| Thaw preserved stem cells CPT 38208 | not published | not published | $27.59 – $435.81 | 7 |
| Theophylline therapeutic drug level CPT 80198 | $269.15 | $269.15 | $6.98 – $168.50 | 9 |
| Therapeutic procd strg endur HCPCS G0237 | $119.60 | $119.60 | $9.92 – $100.46 | 9 |
| Therapy activation ipnss CPT 93150 | not published | not published | $39.69 – $192.10 | 8 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $194.35 | $194.35 | $34.74 – $91.44 | 9 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $171.25 | $171.25 | $28.84 – $85.97 | 9 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $80.30 | $80.30 | $22.24 – $51.04 | 9 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $73.50 | $73.50 | $19.58 – $51.00 | 9 |
| Therapy photodnmc lght dstr lsn skn by staff rx per day CPT 96567 | not published | not published | $129.19 – $267.73 | 8 |
| Ther fx nasal inf turbinate CPT 30930 | not published | not published | $113.68 – $243.32 | 8 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $1,215.05 | $1,215.05 | $96.27 – $1,020.64 | 9 |
| Ther/proph/diag inj ia CPT 96373 | not published | not published | $17.36 – $37.95 | 8 |
| Ther radiology tx plng cplx CPT 77263 | not published | not published | $162.96 – $339.58 | 8 |
| Ther radiology tx plng intrm CPT 77262 | not published | not published | $105.10 – $218.93 | 8 |
| Ther radiology tx plng smpl CPT 77261 | not published | not published | $68.20 – $143.02 | 8 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $21.73 | $21.73 | $1.94 – $7.95 | 9 |
| Thiethylperazine maleate inj HCPCS J3280 | not published | not published | $4.76 – $9.49 | 4 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $304.90 | $304.90 | $8.33 – $197.53 | 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.