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 |
|---|---|---|---|---|
| Tib/per revasc stent & ather 37231 CPT 37231 | $82,998.40 | $82,998.40 | $669.33 – $4,939.91 | 9 |
| Tib/per revasc stnt & ather CPT 37235 | $27,007.65 | $27,007.65 | $340.21 – $2,572.71 | 9 |
| Tib/per revasc w/ather add-on 37233 CPT 37233 | $47,284.90 | $47,284.90 | $290.58 – $1,992.28 | 9 |
| Tic-brn enceph vac 0.25ml im CPT 90626 | not published | not published | $324.16 – $589.34 | 4 |
| Tic-brn enceph vac 0.5ml im CPT 90627 | not published | not published | $324.16 – $589.34 | 4 |
| Tigecycline injection HCPCS J3243 | $1,017.94 | $1,017.94 | $0.58 – $956.86 | 7 |
| Tilt table locking hip sing HCPCS L5270 | not published | not published | $5,671.24 – $14,276.55 | 7 |
| Tilt table study CPT 93660 | $2,251.40 | $2,251.40 | $72.98 – $1,088.26 | 9 |
| Tinzaparin sodium injection HCPCS J1655 | not published | not published | $3.49 – $8.61 | 4 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | $2,432.88 | $2,432.88 | $3.96 – $2,286.91 | 8 |
| Tisagenlecleucel car-pos t HCPCS Q2042 | not published | not published | $0.02 – $995,511.01 | 6 |
| Tis cgen car anomal 1st shnt CPT 33745 | $17,052.90 | $17,052.90 | $969.56 – $14,324.44 | 9 |
| Tis cgen car anomal ea addl CPT 33746 | not published | not published | $387.53 – $851.31 | 8 |
| Tis clt agrft f/s/n/h/f/g ad CPT 15156 | not published | not published | $138.06 – $306.45 | 9 |
| Tis clt agrft f/s/n/h/f/g ea CPT 15157 | not published | not published | $150.37 – $340.51 | 9 |
| Tis cltr skn agrft t/a/l add CPT 15151 | not published | not published | $100.07 – $227.44 | 9 |
| Tis cltr skn agrft t/a/l ea CPT 15152 | not published | not published | $134.78 – $283.33 | 9 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | not published | not published | $165.20 – $335.77 | 8 |
| Tiss ex molecul study add-on CPT 88388 | not published | not published | $22.66 – $49.26 | 7 |
| Tissue amnio epifix inj 100mg HCPCS Q4145 | not published | not published | $21.28 – $61.09 | 4 |
| Tissue culture placenta CPT 88235 | $329.00 | $329.00 | $83.43 – $280.73 | 9 |
| Tissue culture skin/biopsy CPT 88233 | $1,069.80 | $1,069.80 | $79.73 – $267.67 | 9 |
| Tissue culture tumor CPT 88239 | not published | not published | $83.58 – $300.38 | 7 |
| Tissue exam koh skin/hair/nails CPT 87220 | not published | not published | $3.16 – $8.69 | 7 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | not published | not published | $102.85 – $223.98 | 4 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | $4,725.00 | $4,725.00 | $1,977.29 – $2,526.72 | 6 |
| Tissue transglutaminase iga CPT 86364 | $124.45 | $124.45 | $4.61 – $28.11 | 9 |
| Tixagev and cilgav inj HCPCS M0220 | not published | not published | $144.61 – $306.45 | 5 |
| Tl-201 thallium diag per mci HCPCS A9505 | not published | not published | $33.31 – $73.14 | 9 |
| Tlh uterus 250 g or less CPT 58570 | not published | not published | $766.88 – $1,651.11 | 8 |
| Tlh uterus over 250 g CPT 58572 | not published | not published | $985.81 – $2,071.37 | 8 |
| Tlh w/t/o 250 g or less CPT 58571 | not published | not published | $861.78 – $1,855.82 | 8 |
| Tlh w/t/o uterus over 250 g CPT 58573 | not published | not published | $1,152.56 – $2,486.17 | 8 |
| Tlso 2mod symphis-xipho pre HCPCS L0458 | not published | not published | $828.44 – $2,085.46 | 7 |
| Tlso 2 piece rigid shell HCPCS L0491 | not published | not published | $713.41 – $1,795.91 | 7 |
| Tlso 2 shl symphys-stern cst HCPCS L0460 | $2,918.25 | $2,918.25 | $932.46 – $2,743.16 | 9 |
| Tlso 3mod sacro-scap pre HCPCS L0462 | $4,027.30 | $4,027.30 | $1,159.84 – $3,785.66 | 9 |
| Tlso 3 piece rigid shell HCPCS L0492 | not published | not published | $469.46 – $1,181.81 | 7 |
| Tlso corset front HCPCS L0970 | not published | not published | $101.71 – $256.03 | 7 |
| Tlso flex trnk sj-t9 pre ots HCPCS L0455 | not published | not published | $262.28 – $518.52 | 7 |
| Tlso full corset HCPCS L0974 | not published | not published | $200.75 – $505.36 | 7 |
| Tlso r fram soft ant pre cst HCPCS L0466 | not published | not published | $383.58 – $965.61 | 7 |
| Tlso r fram soft pre ots HCPCS L0467 | not published | not published | $294.16 – $581.52 | 7 |
| Tlso rig fram pelvic pre cst HCPCS L0468 | not published | not published | $495.64 – $1,247.70 | 7 |
| Tlso rig fram pelvic pre ots HCPCS L0469 | not published | not published | $374.81 – $740.95 | 7 |
| Tlso rigid frame pre subclav HCPCS L0470 | not published | not published | $703.92 – $1,772.00 | 7 |
| Tlso rigid lined custom fab HCPCS L0482 | not published | not published | $1,546.47 – $3,893.01 | 7 |
| Tlso rigid lined pre one pie HCPCS L0488 | not published | not published | $932.46 – $2,347.33 | 7 |
| Tlso rigid plastic cust fab HCPCS L0484 | not published | not published | $2,108.63 – $5,308.17 | 7 |
| Tlso rigid plastic custom fa HCPCS L0480 | not published | not published | $1,482.06 – $3,730.85 | 7 |
| Tlso rigid plastic pre one HCPCS L0490 | not published | not published | $262.79 – $661.52 | 7 |
| Tlso trnk sj-t9 pre cst HCPCS L0454 | not published | not published | $322.16 – $811.00 | 7 |
| Tmvr w/prosthetic ring 33426 CPT 33426 | not published | not published | $2,167.26 – $4,750.03 | 8 |
| Tmvr w/rad reconst w or without ring 33427 CPT 33427 | not published | not published | $2,217.17 – $4,857.11 | 8 |
| Tnot opn elbw to sho ea tdn CPT 24310 | not published | not published | $460.34 – $984.85 | 8 |
| Tobramycin comp unit HCPCS J7685 | not published | not published | $48.55 – $121.32 | 3 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $763.46 | $763.46 | $2.39 – $9.53 | 9 |
| Tobramycin non-comp unit HCPCS J7682 | not published | not published | $17.04 – $31.64 | 6 |
| Tobramycin peak therapeutic drug level CPT 80200 | $327.20 | $327.20 | $7.96 – $190.59 | 9 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $9,530.45 | $9,530.45 | $5.79 – $3,961.31 | 9 |
| Tocilizumab for covid-19 HCPCS Q0249 | not published | not published | $6.77 – $12.62 | 8 |
| Toe joint transfer CPT 26556 | not published | not published | $3,217.78 – $6,923.06 | 8 |
| Toe X-ray (both feet) CPT 73660 | $330.40 | $330.40 | $6.05 – $186.21 | 9 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | not published | not published | $15.39 – $37.13 | 8 |
| Tomosynthesis breast screen bilateral CPT 77063 | $261.65 | $261.65 | $23.57 – $84.50 | 9 |
| Tone decay hearing test CPT 92563 | not published | not published | $30.89 – $70.49 | 8 |
| Tongue and neck surgery CPT 41135 | not published | not published | $2,052.56 – $4,377.24 | 8 |
| Tongue base vol reduction CPT 41530 | not published | not published | $362.72 – $1,755.21 | 9 |
| Tongue biopsy; posterior one-third 41105 CPT 41105 | not published | not published | $106.39 – $364.27 | 9 |
| Tongue jaw & neck surgery CPT 41155 | not published | not published | $2,817.92 – $6,018.20 | 8 |
| Tongue mouth jaw surgery CPT 41150 | not published | not published | $2,082.32 – $4,439.60 | 8 |
| Tongue mouth neck surgery CPT 41153 | not published | not published | $2,266.27 – $4,834.75 | 8 |
| Tongue removal neck surgery CPT 41145 | not published | not published | $2,599.87 – $5,544.40 | 8 |
| Tongue suspension CPT 41512 | not published | not published | $641.17 – $1,356.96 | 8 |
| Tongue to lip surgery CPT 41510 | not published | not published | $436.63 – $926.55 | 8 |
| Tonsillectomy (age 12+) CPT 42826 | not published | not published | $248.12 – $527.34 | 8 |
| Tonsillectomy (child under 12) CPT 42825 | not published | not published | $260.52 – $553.76 | 8 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $1,425.12 | $1,425.12 | $0.78 – $662.92 | 7 |
| Topotecan oral HCPCS J8705 | not published | not published | $106.46 – $225.12 | 7 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | not published | not published | $39.50 – $77.72 | 6 |
| Torsion ank & half solid sti HCPCS L2375 | not published | not published | $107.72 – $271.16 | 7 |
| Torsion straight knee joint HCPCS L2380 | not published | not published | $109.55 – $275.80 | 7 |
| Tot abd hyst/par vag/pelv node sam 58200 CPT 58200 | not published | not published | $1,279.87 – $2,751.86 | 8 |
| Total hip arthroplasty CPT 27132 | not published | not published | $1,584.42 – $3,399.84 | 8 |
| Total Hip Replacement CPT 27130 | not published | not published | $1,220.81 – $2,618.35 | 8 |
| Total hysterectomy CPT 58150 | not published | not published | $964.84 – $2,075.42 | 8 |
| Total Knee Replacement CPT 27447 | not published | not published | $1,219.28 – $2,614.28 | 8 |
| Total lung lavage CPT 32997 | not published | not published | $314.23 – $669.67 | 8 |
| Total ob care failed vbac 59618 CPT 59618 | not published | not published | $2,514.94 – $5,541.02 | 8 |
| Total tau CPT 84394 | $342.95 | $342.95 | $51.53 – $142.46 | 9 |
| Tot contact ak/knee disart s HCPCS L5650 | not published | not published | $462.84 – $1,165.13 | 7 |
| Tot disc arthrp 1ntrspc crv CPT 22856 | not published | not published | $1,522.02 – $3,329.35 | 8 |
| Tot disc arthrp 1ntrspc lmbr CPT 22857 | not published | not published | $1,655.14 – $3,553.03 | 8 |
| Tot disc arthrp 2ntrspc lmbr CPT 22860 | not published | not published | $379.67 – $694.75 | 8 |
| Tot disc arthrp ant appr disc 2nd level cervi 22858 CPT 22858 | not published | not published | $465.81 – $1,024.15 | 8 |
| Tot esophagectomy without thoracotomy 43107 CPT 43107 | not published | not published | $2,725.37 – $5,976.17 | 8 |
| Tot estradiol response panel CPT 80415 | not published | not published | $27.60 – $113.80 | 7 |
| Toxoplasma antibody igg CPT 86777 | $230.10 | $230.10 | $7.11 – $34.87 | 9 |
| Toxoplasma antibody igm CPT 86778 | $300.55 | $300.55 | $7.11 – $60.82 | 9 |
| Tp53 gene full gene sequence CPT 81351 | $956.35 | $956.35 | $256.74 – $898.97 | 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.