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 |
|---|---|---|---|---|
| Detect agnt mult dna direc CPT 87800 | not published | not published | $19.81 – $88.92 | 7 |
| Determination venous press CPT 93770 | $1,305.45 | $1,305.45 | $1.36 – $513.71 | 8 |
| Determine refractive state CPT 92015 | not published | not published | $18.28 – $37.28 | 7 |
| Developmental screen/score/document 96110 CPT 96110 | $57.10 | $57.10 | $9.92 – $21.19 | 8 |
| Devel tst phys/qhp 1st hr CPT 96112 | $499.25 | $499.25 | $115.66 – $239.00 | 9 |
| Device ablt adv novasure HCPCS C1886 | $4,200.00 | $4,200.00 | $18.10 – $71.92 | 9 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $1,750.00 | $1,750.00 | $1,287.30 – $1,645.00 | 6 |
| Device intraute mirena HCPCS J7298 | $4,919.91 | $4,919.91 | $1,123.73 – $4,097.18 | 9 |
| Device sut capio slim opn HCPCS C2631 | $1,795.00 | $1,795.00 | $1,320.40 – $1,687.30 | 6 |
| Dev interrog remote 1/2/mlt CPT 93295 | not published | not published | $34.28 – $72.52 | 8 |
| Devise bowel pouch CPT 44316 | not published | not published | $1,318.87 – $2,877.94 | 8 |
| Devlopment test interpt&rep HCPCS G0451 | $175.35 | $175.35 | $9.52 – $147.29 | 9 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $231.15 | $231.15 | $47.86 – $107.46 | 9 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | not published | not published | $8.97 – $18.98 | 8 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $98.22 – $223.27 | 8 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $1.17 – $2.34 | 4 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $6.28 | $6.28 | $0.07 – $3.64 | 9 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $59.65 | $59.65 | $0.11 – $8.10 | 9 |
| Dexamethasone intra implant HCPCS J7312 | not published | not published | $195.36 – $394.94 | 8 |
| Dexamethasone panel CPT 80420 | not published | not published | $64.75 – $329.62 | 7 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $0.64 – $1.18 | 6 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $2,791.81 | $2,791.81 | $32.09 – $2,624.30 | 9 |
| Dextran 40 infusion HCPCS J7100 | $447.90 | $447.90 | $17.77 – $421.03 | 6 |
| Dextran 75 infusion HCPCS J7110 | not published | not published | $14.52 – $23.80 | 3 |
| Dextroamphetamine HCPCS S0160 | not published | not published | $0.67 – $1.70 | 3 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $26.54 | $26.54 | $1.16 – $24.95 | 7 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | not published | not published | $7.89 – $15.74 | 4 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $73.05 | $73.05 | $1.68 – $18.39 | 9 |
| Dextrose 5 % IV bolus HCPCS J7070 | not published | not published | $3.36 – $6.92 | 6 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $246.25 | $246.25 | $10.98 – $123.61 | 9 |
| Diabetes (HbA1c) Test CPT 83036 | $166.05 | $166.05 | $7.19 – $105.14 | 9 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | not published | not published | $8.65 – $36.63 | 8 |
| Diabetic custom molded shoe HCPCS A5501 | not published | not published | $211.99 – $529.86 | 7 |
| Diabetic shoe with wedge HCPCS A5504 | not published | not published | $34.00 – $90.10 | 7 |
| Diabetic shoe w/off set heel HCPCS A5506 | not published | not published | $34.00 – $90.10 | 7 |
| Diabetic shoe w/roller/rockr HCPCS A5503 | not published | not published | $34.00 – $90.10 | 7 |
| Diab manage trn ind/group HCPCS G0109 | $43.10 | $43.10 | $14.65 – $36.29 | 9 |
| Diab shoe for density insert HCPCS A5500 | not published | not published | $70.68 – $176.68 | 7 |
| Diab shoe w/metatarsal bar HCPCS A5505 | not published | not published | $34.00 – $90.10 | 7 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $158.44 – $336.20 | 8 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $312.17 – $673.74 | 8 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $88.95 – $289.12 | 9 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $117.25 – $400.26 | 9 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $227.75 | $227.75 | $33.80 – $83.69 | 9 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $261.65 | $261.65 | $15.39 – $94.56 | 9 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $261.65 | $261.65 | $15.39 – $94.56 | 9 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $391.05 | $391.05 | $47.29 – $173.46 | 9 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $411.75 | $411.75 | $65.36 – $237.10 | 9 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $1,021.80 | $1,021.80 | $44.98 – $567.55 | 9 |
| Diagnostic Mammogram (one breast) CPT 77065 | $854.40 | $854.40 | $36.54 – $369.94 | 9 |
| Diagnostic radio unlisted proc CPT 76499 | $1,366.35 | $1,366.35 | $85.22 – $169.53 | 9 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $3,902.65 | $3,902.65 | $182.63 – $3,278.23 | 9 |
| Dialysis one evaluation CPT 90945 | $1,196.55 | $1,196.55 | $82.37 – $1,005.10 | 9 |
| Dialysis repeated eval CPT 90947 | $3,796.60 | $3,796.60 | $115.89 – $776.37 | 9 |
| Dialysis training complete CPT 90989 | not published | not published | $416.38 – $849.28 | 4 |
| Dialysis training incompl CPT 90993 | not published | not published | $90.12 – $185.03 | 4 |
| Diathermy eg microwave CPT 97024 | not published | not published | $6.99 – $14.90 | 8 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $134.50 | $134.50 | $0.07 – $101.71 | 9 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $250.52 | $250.52 | $5.45 – $167.60 | 9 |
| Dicyclomine injection HCPCS J0500 | $198.50 | $198.50 | $20.33 – $186.59 | 7 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.08 – $0.47 | 8 |
| Diffusing capacity CPT 94729 | $303.45 | $303.45 | $8.32 – $21.33 | 9 |
| Digital analysis of eeg CPT 95957 | $1,992.90 | $1,992.90 | $95.97 – $1,674.04 | 9 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $167.65 – $362.63 | 8 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $55.99 | $55.99 | $3.72 – $10.29 | 9 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $17,849.20 | $17,849.20 | $4,685.44 – $8,273.73 | 9 |
| Digoxin total therapeutic drug level CPT 80162 | $270.00 | $270.00 | $6.56 – $157.40 | 9 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $42.34 – $71.31 | 6 |
| Dilate biliary duct/ampulla CPT 47542 | $2,676.40 | $2,676.40 | $125.18 – $941.21 | 9 |
| Dilate esophagus CPT 43453 | $2,745.45 | $2,745.45 | $82.16 – $1,524.57 | 9 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $75.57 – $361.07 | 9 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $1,659.40 | $1,659.40 | $325.88 – $1,559.84 | 8 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $1,659.40 | $1,659.40 | $162.94 – $1,559.84 | 8 |
| Dilate ic vasospasm init CPT 61640 | $1,659.40 | $1,659.40 | $463.87 – $1,559.84 | 8 |
| Dilate tear duct opening CPT 68801 | not published | not published | $75.22 – $185.68 | 9 |
| Dilate urethra stricture CPT 53600 | not published | not published | $60.21 – $170.89 | 9 |
| Dilate urethra stricture CPT 53601 | not published | not published | $50.50 – $165.76 | 9 |
| Dilate urethra stricture CPT 53605 | not published | not published | $59.86 – $128.10 | 8 |
| Dilate urethra stricture CPT 53621 | not published | not published | $67.69 – $314.17 | 9 |
| Dilation/female urethra/initial 53660 CPT 53660 | $288.15 | $288.15 | $39.39 – $147.12 | 9 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $163.57 – $348.39 | 8 |
| Dilation of cervical canal 57800 CPT 57800 | $5,113.90 | $5,113.90 | $45.67 – $150.98 | 9 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $185.29 – $394.47 | 8 |
| Dilation of salivary duct CPT 42660 | not published | not published | $75.95 – $216.52 | 9 |
| Dilation of urethra CPT 53661 | not published | not published | $38.08 – $144.55 | 9 |
| Dilation of urethra CPT 53665 | not published | not published | $35.12 – $75.23 | 8 |
| Dilation of vagina CPT 57400 | not published | not published | $122.95 – $265.01 | 8 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $56.62 – $144.55 | 9 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $1,241.20 | $1,241.20 | $82.18 – $327.66 | 9 |
| Dilator fascial 10fx20cm HCPCS C2627 | $179.00 | $179.00 | $31.45 – $63.29 | 9 |
| Dilat xst trc ndurlgc px CPT 50436 | $9,587.85 | $9,587.85 | $142.56 – $3,045.42 | 9 |
| Dilat xst trc new access rcs CPT 50437 | $9,587.85 | $9,587.85 | $236.33 – $5,123.75 | 9 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $54.55 – $117.79 | 5 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $7.38 – $17.02 | 6 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $4,419.22 | $4,419.22 | $651.47 – $2,887.92 | 9 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | not published | not published | $0.02 – $0.67 | 4 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $30.64 | $30.64 | $0.80 – $22.51 | 9 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $35.25 – $108.33 | 4 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $3.72 – $7.19 | 6 |
| Direct advanced life support CPT 99288 | not published | not published | $403.47 – $403.47 | 1 |
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.