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 |
|---|---|---|---|---|
| Above knee cushion socket HCPCS L5648 | not published | not published | $624.20 – $1,571.32 | 7 |
| Above knee flex cover system HCPCS L5964 | not published | not published | $1,009.62 – $2,541.58 | 7 |
| Above knee hydracadence HCPCS L5610 | not published | not published | $2,345.44 – $5,904.29 | 7 |
| Above knee leather socket HCPCS L5642 | not published | not published | $587.39 – $1,478.69 | 7 |
| Above knee manual lock HCPCS L5925 | not published | not published | $318.56 – $801.94 | 7 |
| Above knee wood socket HCPCS L5644 | not published | not published | $734.79 – $1,849.72 | 7 |
| Abrasion lesions add-on CPT 15787 | not published | not published | $16.22 – $57.82 | 9 |
| Abrasion lesion single CPT 15786 | not published | not published | $130.02 – $443.30 | 9 |
| Abscess drain retroperitoneal surg code CPT 49406 | $6,610.20 | $6,610.20 | $180.76 – $1,677.47 | 9 |
| Absorpt drg >16<=48 in w/bdr HCPCS A6255 | not published | not published | $3.38 – $8.45 | 7 |
| Absorpt drg >16 <=48 without bdr HCPCS A6252 | not published | not published | $3.62 – $9.04 | 7 |
| Absorpt drg <=16 sq in w/bdr HCPCS A6254 | not published | not published | $1.33 – $3.32 | 7 |
| Absorpt drg <=16 sq in without b HCPCS A6251 | not published | not published | $2.22 – $5.52 | 7 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | not published | not published | $7.04 – $17.59 | 7 |
| Access & clsr pq fem art endogft dlvry w/img uni CPT 34713 | not published | not published | $109.97 – $243.33 | 8 |
| Access thoracic lymph duct CPT 38794 | $3,347.75 | $3,347.75 | $270.01 – $2,812.11 | 9 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $116.05 | $116.05 | $0.05 – $103.34 | 9 |
| Acetaminophen level CPT 80143 | $349.30 | $349.30 | $7.46 – $232.56 | 9 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $211.85 | $211.85 | $24.04 – $199.14 | 9 |
| Acetone qualitative CPT 82009 | $148.15 | $148.15 | $2.23 – $41.22 | 9 |
| Acetylcholine receptor modulating antibody CPT 86043 | $157.15 | $157.15 | $12.05 – $94.24 | 9 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $5.52 – $25.02 | 7 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $253.17 | $253.17 | $0.57 – $237.98 | 7 |
| Acetylcysteine non-comp unit HCPCS J7608 | not published | not published | $6.32 – $16.11 | 6 |
| Acid perfusion of esophagus CPT 91030 | not published | not published | $43.49 – $91.51 | 8 |
| Acne surgery 10040 CPT 10040 | $288.45 | $288.45 | $49.56 – $212.70 | 9 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | not published | not published | $159.51 – $336.19 | 8 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | not published | not published | $125.37 – $265.01 | 8 |
| Aco ccm; at least 20 min 99490aco CPT 99490 | not published | not published | $47.37 – $120.79 | 9 |
| Aco ccm; ea addl 20 min 99439aco CPT 99439 | not published | not published | $32.66 – $92.52 | 9 |
| Aco cmplx chron care addl 20 min 99489aco CPT 99489 | not published | not published | $46.71 – $139.42 | 9 |
| Aco cmplx chron care without pt visit, 60 min 99487aco CPT 99487 | not published | not published | $83.71 – $258.92 | 9 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | not published | not published | $124.73 – $292.12 | 8 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | $60.85 | $60.85 | $8.65 – $36.63 | 9 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $126.05 | $126.05 | $14.85 – $32.13 | 9 |
| Acoustic immitance testing CPT 92570 | not published | not published | $27.71 – $61.68 | 9 |
| Acoustic refl threshold tst CPT 92568 | not published | not published | $14.50 – $29.83 | 9 |
| Acromp/acromionectomy prtl CPT 23130 | not published | not published | $597.09 – $1,280.36 | 8 |
| Acth stimulation panel CPT 80402 | not published | not published | $42.94 – $177.07 | 7 |
| Acth stimulation panel CPT 80406 | not published | not published | $38.65 – $159.35 | 7 |
| Actigraphy testing CPT 95803 | not published | not published | $39.68 – $83.36 | 8 |
| Actinotherapy uv light CPT 96900 | $112.00 | $112.00 | $18.24 – $47.79 | 9 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | not published | not published | $23.70 – $87.37 | 9 |
| Acup 1/> w/estim ea addl 15 CPT 97814 | not published | not published | $23.04 – $70.67 | 9 |
| Acup 1/> without estim ea add 15 CPT 97811 | not published | not published | $22.72 – $54.62 | 9 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | not published | not published | $23.70 – $73.88 | 9 |
| Acute hepatitis panel CPT 80074 | $584.80 | $584.80 | $23.52 – $277.35 | 9 |
| Acute venous thrombus image CPT 78456 | not published | not published | $44.44 – $92.85 | 8 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $166.90 | $166.90 | $0.04 – $156.89 | 9 |
| #acylcarnitineprfl CPT 82017 | $750.25 | $750.25 | $8.33 – $112.61 | 9 |
| Acylcarnitines qual CPT 82016 | not published | not published | $6.85 – $33.58 | 7 |
| Adalimumab injection HCPCS J0135 | not published | not published | $535.46 – $4,376.60 | 5 |
| Adapt behavior tx phys/qhp CPT 97155 | not published | not published | $26.42 – $160.17 | 7 |
| Adapter b 8 channel 10cm HCPCS C1883 | $1,453.60 | $1,453.60 | $31.93 – $88.40 | 9 |
| Adaptive behavior tx by tech CPT 97153 | not published | not published | $17.08 – $92.21 | 7 |
| Adding walker to prev cast CPT 29440 | $66.00 | $66.00 | $26.49 – $84.16 | 9 |
| Additional switch, ext power HCPCS L6611 | not published | not published | $383.22 – $964.71 | 7 |
| Add le poly knee custom kafo HCPCS L2387 | not published | not published | $196.37 – $494.31 | 7 |
| Add ue prost a/e acrylic HCPCS L7404 | not published | not published | $517.32 – $1,302.29 | 7 |
| Add ue prost a/e ultlite mat HCPCS L7401 | not published | not published | $319.35 – $803.93 | 7 |
| Add ue prost b/e acrylic HCPCS L7403 | not published | not published | $342.74 – $862.80 | 7 |
| Add ue prost be/wd, ultlite HCPCS L7400 | not published | not published | $285.27 – $718.11 | 7 |
| Add ue prost s/d acrylic HCPCS L7405 | not published | not published | $676.58 – $1,703.18 | 7 |
| Add ue prost s/d ultlite mat HCPCS L7402 | not published | not published | $344.88 – $868.17 | 7 |
| Add up-ex prosthes lock mech HCPCS L6698 | not published | not published | $471.59 – $1,187.17 | 7 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $1,995.07 | $1,995.07 | $0.42 – $764.54 | 7 |
| Adenovirus ag ia CPT 87301 | not published | not published | $5.92 – $25.08 | 7 |
| Adenovirus antibody,serum - quest CPT 86603 | not published | not published | $6.36 – $26.21 | 7 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $13.06 – $44.31 | 7 |
| Adenovirus vaccine type 4 CPT 90476 | not published | not published | $90.59 – $93.67 | 2 |
| Adhesiolysis tube ovary 58740 CPT 58740 | not published | not published | $855.86 – $1,843.62 | 8 |
| Adhesive, liquid or equal HCPCS A4364 | not published | not published | $3.20 – $8.17 | 7 |
| Adh-sendout CPT 84588 | $316.85 | $316.85 | $16.76 – $240.50 | 9 |
| Adj gastric band via subq port CPT 43999 | $3,338.85 | $3,338.85 | $167.02 – $934.63 | 9 |
| Adjmt/revj ext fixj sys anes CPT 20693 | not published | not published | $427.51 – $920.44 | 8 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | not published | not published | $731.95 – $1,787.34 | 9 |
| Adjustment gastric band HCPCS S2083 | not published | not published | $53.99 – $53.99 | 1 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $4,371.64 | $4,371.64 | $0.23 – $0.57 | 9 |
| Admin ecg contrast agent CPT 93352 | $422.20 | $422.20 | $32.04 – $70.49 | 9 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $508.25 | $508.25 | $25.67 – $147.29 | 9 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $268.20 | $268.20 | $59.15 – $186.94 | 9 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $1,009.70 | $1,009.70 | $119.99 – $484.74 | 9 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $680.95 | $680.95 | $92.95 – $331.58 | 9 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $676.55 | $676.55 | $32.04 – $106.89 | 9 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $643.95 | $643.95 | $43.16 – $119.33 | 9 |
| Administration immunization each additional component CPT 90461 | not published | not published | $8.33 – $17.61 | 8 |
| Administration immunization each additional vaccine CPT 90472 | $51.60 | $51.60 | $13.85 – $29.82 | 9 |
| Administration immunization first component each vaccine CPT 90460 | not published | not published | $21.48 – $46.77 | 8 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $45.30 | $45.30 | $15.80 – $33.88 | 9 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $53.45 | $53.45 | $11.35 – $26.73 | 9 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | not published | not published | $22.38 – $46.10 | 8 |
| Administration vaccine hepatitis b HCPCS G0010 | $71.05 | $71.05 | $25.74 – $58.52 | 9 |
| Administration vaccine pneumococcal HCPCS G0009 | not published | not published | $25.74 – $66.42 | 7 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $59.40 | $59.40 | $10.20 – $39.98 | 9 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $22,906.85 | $22,906.85 | $36.98 – $7,318.26 | 9 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $33.62 – $70.49 | 8 |
| Adrenalectomy expl w/exc retro tumor 60545 CPT 60545 | not published | not published | $1,165.70 – $2,539.71 | 8 |
| Adrenalin epinephrine inject HCPCS J0171 | $1,526.91 | $1,526.91 | $0.75 – $16.58 | 9 |
| Advance care planning each additional 30 min 99498 CPT 99498 | $246.00 | $246.00 | $48.55 – $77.86 | 9 |
| Adv prim care mgmt lvl 1 HCPCS G0556 | not published | not published | $11.78 – $25.08 | 6 |
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.