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 |
|---|---|---|---|---|
| Trimethobenzamide hci 250mg HCPCS Q0173 | not published | not published | $0.84 – $1.38 | 4 |
| Trimethobenzamide hcl inj HCPCS J3250 | not published | not published | $45.84 – $93.30 | 6 |
| Trim nail(s) HCPCS G0127 | $215.10 | $215.10 | $7.02 – $46.26 | 9 |
| Trim nondyst nails CPT 11719 | $266.95 | $266.95 | $7.02 – $27.62 | 9 |
| Triptorelin pamoate HCPCS J3315 | $9,837.05 | $9,837.05 | $371.93 – $3,616.09 | 9 |
| Trluml dil aq o/f can without st CPT 66174 | not published | not published | $594.25 – $1,256.63 | 8 |
| Trluml dil aq o/f can w/st CPT 66175 | not published | not published | $691.22 – $1,455.91 | 8 |
| Trml dstrj ios bvn 1st 2 l/s CPT 64628 | not published | not published | $392.07 – $836.41 | 8 |
| Trml dstrj ios bvn ea addl CPT 64629 | not published | not published | $184.10 – $394.49 | 8 |
| Trmt of fracture (femoral shaft) 27500 CPT 27500 | not published | not published | $232.17 – $1,032.44 | 9 |
| Trnscath plc stent crv crtd without prtct CPT 37216 | $11,001.75 | $11,001.75 | $950.49 – $10,341.65 | 8 |
| Trnscath plc stent crv crtd w/prtct CPT 37215 | $11,418.60 | $11,418.60 | $890.46 – $9,591.62 | 9 |
| Trnscath plc stnt ante carotid art CPT 37218 | not published | not published | $753.22 – $1,647.06 | 8 |
| Trnscath plc vas stent w/s&i ea addl artery CPT 37237 | $14,056.55 | $14,056.55 | $189.38 – $2,437.51 | 9 |
| Trnscath plc vas stent w/s&i ea addl vein CPT 37239 | $23,824.55 | $23,824.55 | $136.63 – $3,252.16 | 9 |
| Trnscath plc vas stent w/s&i ini vein CPT 37238 | $49,264.05 | $49,264.05 | $278.02 – $6,507.53 | 9 |
| Trnscath retrv pq vasc fb w/guide CPT 37197 | $5,782.35 | $5,782.35 | $274.32 – $2,868.30 | 9 |
| Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 | $2,998.35 | $2,998.35 | $350.62 – $1,670.68 | 9 |
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $6,688.10 | $6,688.10 | $209.88 – $4,510.59 | 9 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $6,688.10 | $6,688.10 | $111.02 – $1,257.19 | 9 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $2,998.35 | $2,998.35 | $307.63 – $1,807.68 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | $6,994.05 | $6,994.05 | $830.65 – $2,093.79 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/< CPT 14302 | $3,961.10 | $3,961.10 | $201.44 – $3,216.65 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | not published | not published | $638.91 – $1,487.96 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm CPT 14061 | not published | not published | $785.40 – $1,929.33 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | not published | not published | $679.42 – $1,680.04 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | $623.83 – $1,572.76 | 9 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | $481.10 – $1,235.47 | 9 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $208.00 – $1,304.65 | 7 |
| Trnspl rej kdn mrna qpcr 139 CPT 81558 | not published | not published | $3,240.00 – $6,789.21 | 6 |
| Trnsxj/repos abrrnt rnl vsls CPT 50100 | not published | not published | $1,013.73 – $2,205.57 | 8 |
| Troponin quantitative CPT 84484 | $149.15 | $149.15 | $4.99 – $90.80 | 9 |
| Tr retinal les preterm inf CPT 67229 | $1,048.50 | $1,048.50 | $530.96 – $985.59 | 9 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | $366.09 – $3,193.05 | 9 |
| Truskin, per sq centimeter HCPCS Q4167 | not published | not published | $102.80 – $246.26 | 5 |
| Truss addition to std pad wa HCPCS L8320 | not published | not published | $67.13 – $168.96 | 7 |
| Truss add to std pad scrotal HCPCS L8330 | not published | not published | $62.41 – $157.09 | 7 |
| Truss double with standard pad HCPCS L8310 | not published | not published | $126.26 – $317.87 | 7 |
| Truss single with standard pad HCPCS L8300 | not published | not published | $79.98 – $201.32 | 7 |
| Tte w or without contr, cont ecg HCPCS C8930 | $2,075.90 | $2,075.90 | $764.65 – $1,843.01 | 9 |
| Tte w or without fol w/con,stres HCPCS C8928 | $3,526.65 | $3,526.65 | $764.65 – $1,694.40 | 9 |
| Tte w or without fol w/cont, com HCPCS C8921 | $2,028.05 | $2,028.05 | $764.65 – $1,906.37 | 9 |
| Tte w or without fol w/cont, f/u HCPCS C8922 | $2,028.05 | $2,028.05 | $764.65 – $1,906.37 | 9 |
| Tubal Ligation (Laparoscopic) CPT 58670 | not published | not published | $353.47 – $760.50 | 8 |
| Tube drain vert dev st 5-40f HCPCS A5200 | not published | not published | $12.57 – $31.42 | 7 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | not published | not published | $52.29 – $130.70 | 7 |
| Tube trach disp innr can 6 xlt HCPCS A4623 | not published | not published | $7.28 – $18.22 | 7 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | not published | not published | $52.78 – $131.91 | 7 |
| Tubing (oxygen) per foot HCPCS A4616 | not published | not published | $0.06 – $0.16 | 7 |
| Tubular dressing HCPCS A6457 | $31.75 | $31.75 | $1.26 – $29.85 | 9 |
| Tumor cell deplete of harvst CPT 38211 | not published | not published | $70.11 – $435.81 | 7 |
| Tvh >250 gms 58290 CPT 58290 | not published | not published | $1,084.83 – $2,343.83 | 8 |
| Tvh w/mmk 58267 CPT 58267 | not published | not published | $1,010.15 – $2,179.80 | 8 |
| Twelve volt battery utah/equ HCPCS L7364 | not published | not published | $477.36 – $1,201.68 | 7 |
| Tx atrial fib pulm vein isol CPT 93656 | $26,172.95 | $26,172.95 | $856.93 – $21,985.28 | 9 |
| Tx closed distal humerus fx CPT 24999 | $3,909.30 | $3,909.30 | $178.78 – $281.48 | 9 |
| Tx closed hip disl traumatic without anes CPT 27250 | $568.80 | $568.80 | $150.35 – $335.11 | 9 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $5,681.45 | $5,681.45 | $560.52 – $1,225.82 | 9 |
| Tx closed tib shaft fx without manip CPT 27750 | not published | not published | $232.17 – $699.01 | 9 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $105.68 – $309.02 | 9 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $68.48 – $210.09 | 9 |
| Tx ectopic pregnancy abdl pregnancy 59130 CPT 59130 | not published | not published | $879.16 – $1,941.21 | 8 |
| Tx ectopic pregnancy ntrstl prtl rescj uter 59136 CPT 59136 | not published | not published | $834.55 – $1,842.94 | 8 |
| Tx l/r atrial fib addl CPT 93657 | $7,279.30 | $7,279.30 | $277.76 – $6,114.61 | 9 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | not published | not published | $717.30 – $1,531.14 | 8 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | $5,450.80 | $5,450.80 | $280.03 – $570.70 | 9 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | not published | not published | $530.99 – $1,138.03 | 8 |
| Tx open nsl fx uncomp CPT 21325 | not published | not published | $428.66 – $909.61 | 8 |
| Tx open nsl sptl fx CPT 21336 | not published | not published | $613.15 – $1,302.73 | 8 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | not published | not published | $575.63 – $1,234.96 | 8 |
| Tx septic abortion surgical 59830 CPT 59830 | not published | not published | $433.79 – $950.95 | 8 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | not published | not published | $185.73 – $421.45 | 9 |
| Tympanic membrane repair CPT 69610 | not published | not published | $274.70 – $743.98 | 9 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $525.08 – $1,111.59 | 8 |
| Tympanometry & reflex thresh CPT 92550 | not published | not published | $21.03 – $44.06 | 8 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | not published | not published | $127.72 – $392.54 | 9 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $1,346.95 – $2,854.21 | 8 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $1,226.21 – $2,606.83 | 8 |
| Tyms gene com variants CPT 81346 | not published | not published | $174.81 – $355.95 | 7 |
| Typhoid vaccine oral CPT 90690 | not published | not published | $66.42 – $174.84 | 4 |
| U2af1 gene common variants CPT 81357 | not published | not published | $77.30 – $393.50 | 7 |
| Ua w/micro/comp poc CPT 81000 | $107.45 | $107.45 | $2.41 – $25.85 | 9 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | $15,137.87 | $15,137.87 | $67.66 – $14,229.60 | 9 |
| Ue triple control harness HCPCS L6677 | not published | not published | $276.10 – $695.04 | 7 |
| Ugt1a1 gene analy common variants CPT 81350 | not published | not published | $57.96 – $476.47 | 7 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $2.48 – $5.42 | 8 |
| Ultrasound breast complete CPT 76641 | $606.75 | $606.75 | $33.30 – $189.59 | 9 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $606.75 | $606.75 | $31.03 – $189.59 | 9 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $397.70 | $397.70 | $20.18 – $268.34 | 9 |
| Ultrasound dx ophth b-scan CPT 76512 | $265.85 | $265.85 | $17.23 – $153.17 | 9 |
| Ultrasound elastography ea l target les CPT 76983 | $302.60 | $302.60 | $22.17 – $254.18 | 9 |
| Ultrasound elastography parenchyma CPT 76981 | $302.60 | $302.60 | $27.25 – $254.18 | 9 |
| Ultrasound encephalogram CPT 76506 | $797.45 | $797.45 | $28.76 – $669.86 | 9 |
| Ultrasound exam follow-up CPT 76970 | not published | not published | $38.71 – $38.71 | 1 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $2,025.10 | $2,025.10 | $34.27 – $169.76 | 9 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $985.60 | $985.60 | $34.82 – $720.46 | 9 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $1,119.90 | $1,119.90 | $28.36 – $58.97 | 9 |
| Ultrasound guidance for vascular access CPT 76937 | $240.55 | $240.55 | $12.75 – $29.36 | 9 |
| Ultrasound guide intraoperative CPT 76998 | $1,506.65 | $1,506.65 | $43.31 – $444.28 | 9 |
| Ultrasound guide tissue ablation CPT 76940 | $767.80 | $767.80 | $72.29 – $644.95 | 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.