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 |
|---|---|---|---|---|
| Unlisted surgical path px CPT 88399 | $1,193.55 | $1,193.55 | $51.71 – $1,121.94 | 9 |
| Unlisted transfusion med px CPT 86999 | $451.00 | $451.00 | $23.70 – $48.55 | 9 |
| Unlisted ultrasound procedure CPT 76999 | $1,120.15 | $1,120.15 | $85.22 – $146.03 | 9 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $598.38 – $616.33 | 5 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $388.91 – $400.57 | 5 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $5,646.73 – $5,816.13 | 5 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $5,646.73 – $5,816.13 | 5 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $3,758.00 | $3,758.00 | $677.22 – $1,279.15 | 9 |
| Upgrade pm system CPT 33214 | $5,203.95 | $5,203.95 | $441.75 – $4,371.32 | 9 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $393.95 | $393.95 | $7.35 – $150.74 | 9 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $2,481.90 | $2,481.90 | $55.14 – $1,462.48 | 9 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $2,107.70 | $2,107.70 | $44.98 – $854.32 | 9 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $8,730.55 | $8,730.55 | $104.00 – $2,519.33 | 9 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $4,713.95 | $4,713.95 | $80.55 – $2,085.05 | 9 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $4,362.00 | $4,362.00 | $67.03 – $1,552.82 | 9 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $534.95 | $534.95 | $9.30 – $291.96 | 9 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $534.95 | $534.95 | $10.27 – $330.44 | 9 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $115.56 – $554.44 | 9 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $129.94 – $724.70 | 9 |
| Upper ext fx orthosis rad/ul HCPCS L3982 | not published | not published | $378.32 – $952.37 | 7 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $167.22 – $368.72 | 8 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $1,054.10 | $1,054.10 | $40.44 – $732.54 | 9 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $1,122.85 | $1,122.85 | $36.55 – $647.79 | 9 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $129.94 – $772.25 | 9 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $609.98 – $1,293.92 | 8 |
| Urea nitrogen CPT 84520 | $87.50 | $87.50 | $1.95 – $37.32 | 9 |
| Urea nitrogen 24 hour urine CPT 84540 | $103.80 | $103.80 | $2.34 – $37.04 | 9 |
| Urea nitrogen clearance CPT 84545 | $179.45 | $179.45 | $3.26 – $59.41 | 9 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $2.05 – $10.45 | 7 |
| Ureteral embolization/occl CPT 50705 | $5,096.50 | $5,096.50 | $164.54 – $3,450.69 | 9 |
| Ureteral reflux study CPT 78740 | $1,185.35 | $1,185.35 | $25.74 – $995.69 | 9 |
| Ureter endoscopy CPT 50970 | $5,834.50 | $5,834.50 | $346.76 – $4,900.98 | 9 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $330.02 – $821.08 | 9 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $441.83 – $943.49 | 8 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $335.09 – $713.73 | 8 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $331.64 – $828.78 | 9 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $295.55 – $748.47 | 9 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $435.89 – $930.62 | 8 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $332.93 – $710.33 | 8 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $1,051.53 – $2,248.94 | 8 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $1,064.25 – $2,285.53 | 8 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $927.65 | $927.65 | $14.81 – $347.09 | 9 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $709.72 – $1,519.64 | 8 |
| Urethrocystography void s&i CPT 74455 | $839.95 | $839.95 | $14.81 – $672.38 | 9 |
| Uric acid blood CPT 84550 | $103.55 | $103.55 | $3.35 – $44.74 | 9 |
| Uric acid urine CPT 84560 | $112.10 | $112.10 | $2.34 – $59.03 | 9 |
| Urinalysis glass test CPT 81020 | not published | not published | $1.88 – $9.57 | 7 |
| Urinalysis microscopic only CPT 81015 | $82.95 | $82.95 | $2.26 – $30.93 | 9 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $1.07 – $4.42 | 7 |
| Urinalysis (with microscopy) CPT 81001 | $100.55 | $100.55 | $2.35 – $33.42 | 9 |
| Urinalysis (without microscopy) CPT 81003 | $47.70 | $47.70 | $1.66 – $22.14 | 9 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $7.06 – $14.90 | 8 |
| Urinary pouch on barr w/flng HCPCS A5073 | not published | not published | $3.53 – $8.84 | 7 |
| Urinary pouch w/barrier HCPCS A5071 | not published | not published | $6.68 – $16.70 | 7 |
| Urinary reflex study CPT 51792 | not published | not published | $52.40 – $111.16 | 8 |
| Urinary suspensory HCPCS A5105 | not published | not published | $38.52 – $96.29 | 7 |
| Urine Culture Test CPT 87086 | $163.80 | $163.80 | $3.98 – $76.23 | 9 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $5.45 – $15.42 | 8 |
| Urine ost pouch w faucet/tap HCPCS A4428 | not published | not published | $7.24 – $18.12 | 7 |
| Urine pregnancy test CPT 81025 | $35.25 | $35.25 | $5.17 – $29.23 | 9 |
| Urine screen for bacteria CPT 81007 | not published | not published | $5.29 – $61.05 | 7 |
| Urine shunt to intestine CPT 50815 | not published | not published | $1,160.88 – $2,469.91 | 8 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $1.20 – $17.98 | 7 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $63.43 – $205.13 | 4 |
| Urography, antegrade CPT 74425 | $938.00 | $938.00 | $23.03 – $347.09 | 9 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $22.17 – $46.10 | 8 |
| Urokinase 250,000 iu inj HCPCS J3365 | not published | not published | $457.73 – $849.34 | 3 |
| Urokinase 5000 iu injection HCPCS J3364 | not published | not published | $9.16 – $16.98 | 3 |
| Use 1st target lesion CPT 76982 | $302.60 | $302.60 | $26.92 – $254.18 | 9 |
| User adjustable heel height HCPCS L5990 | not published | not published | $1,688.56 – $4,250.69 | 7 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $7,606.40 | $7,606.40 | $12.50 – $7,150.02 | 9 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | not published | not published | $153.96 – $293.07 | 8 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $12,453.02 – $12,826.61 | 5 |
| Vaccine Administration (one shot) CPT 90471 | $59.40 | $59.40 | $19.24 – $42.01 | 9 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $160.00 | $160.00 | $54.40 – $150.40 | 9 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | not published | not published | $143.36 – $280.30 | 8 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | not published | not published | $128.80 – $251.84 | 8 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | not published | not published | $86.24 – $168.62 | 8 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | not published | not published | $64.40 – $125.92 | 8 |
| Vaccine dtap < 7 years im CPT 90700 | $37.90 | $37.90 | $27.88 – $35.63 | 6 |
| Vaccine dtap-hep b-ipv im CPT 90723 | not published | not published | $109.73 – $151.83 | 4 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | not published | not published | $68.41 – $124.37 | 4 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | not published | not published | $168.95 – $298.00 | 4 |
| Vaccine dtap-ipv/hib im CPT 90698 | not published | not published | $128.26 – $182.43 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | not published | not published | $33.28 – $49.47 | 4 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | not published | not published | $13.50 – $46.10 | 4 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $876.97 | $876.97 | $58.96 – $152.28 | 9 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $753.18 | $753.18 | $95.55 – $122.11 | 6 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $790.84 | $790.84 | $30.05 – $145.49 | 9 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | not published | not published | $36.43 – $61.00 | 3 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | not published | not published | $74.85 – $144.35 | 8 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $61.65 | $61.65 | $45.35 – $72.49 | 9 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $1,585.45 | $1,585.45 | $155.12 – $307.89 | 9 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $1,901.42 | $1,901.42 | $11.48 – $32.62 | 9 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $3,131.29 | $3,131.29 | $248.14 – $585.49 | 6 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $220.40 | $220.40 | $162.13 – $207.18 | 6 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $746.80 | $746.80 | $51.38 – $141.01 | 9 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $58.62 – $106.57 | 8 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $28.25 | $28.25 | $16.32 – $24.63 | 9 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $200.84 | $200.84 | $16.40 – $23.02 | 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.