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 |
|---|---|---|---|---|
| Adv prim care mgmt lvl 2 HCPCS G0557 | not published | not published | $28.83 – $75.92 | 6 |
| Adv prim care mgmt lvl 3 HCPCS G0558 | not published | not published | $78.82 – $167.43 | 6 |
| Aep hearing status deter i&r CPT 92651 | $152.00 | $152.00 | $76.73 – $142.88 | 9 |
| Aep neurodiagnostic i&r CPT 92653 | $460.70 | $460.70 | $78.56 – $386.99 | 9 |
| Aep thrshld est mlt freq i&r CPT 92652 | $502.50 | $502.50 | $105.00 – $422.10 | 9 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $2,943.42 – $7,262.49 | 8 |
| Afamitresgene autoleucel HCPCS Q2057 | not published | not published | $770,620.00 – $793,738.60 | 5 |
| _afb id by dna probe rflx ast CPT 87149 | $196.25 | $196.25 | $9.90 – $60.72 | 9 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $2.92 – $14.88 | 7 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | not published | not published | $56.97 – $234.90 | 7 |
| Aff2 gen aly detc abnl allel CPT 81171 | not published | not published | $54.80 – $278.96 | 7 |
| Aff2 gen alys charac alleles CPT 81172 | not published | not published | $109.93 – $559.61 | 7 |
| Aflibercept injection HCPCS J0178 | $6,804.70 | $6,804.70 | $790.04 – $6,396.42 | 9 |
| Afluria vacc, 3 yrs & >, im HCPCS Q2035 | not published | not published | $11.89 – $31.50 | 4 |
| Afo molded ankle gauntlet HCPCS L1904 | not published | not published | $557.95 – $1,404.57 | 7 |
| Afo molded plas rig ant tib HCPCS L1945 | not published | not published | $1,098.36 – $2,764.98 | 7 |
| Afo molded to patient plasti HCPCS L1940 | not published | not published | $586.80 – $1,477.18 | 7 |
| Afo rig ant tib tcf/= custom HCPCS L1932 | not published | not published | $828.92 – $2,086.70 | 7 |
| Afo sing bar clasp attach sh HCPCS L1910 | not published | not published | $282.15 – $710.27 | 7 |
| Afo sing solid stirrup calf HCPCS L1980 | not published | not published | $422.47 – $1,063.53 | 7 |
| Afo sing upright with adjust s HCPCS L1920 | not published | not published | $413.49 – $1,040.89 | 7 |
| Afo spiral molded to pt plas HCPCS L1950 | not published | not published | $848.69 – $2,136.46 | 7 |
| Afo sprng wir drsflx calf bd HCPCS L1900 | not published | not published | $282.64 – $711.53 | 7 |
| Afo supramalleolar custom HCPCS L1907 | not published | not published | $522.69 – $1,315.81 | 7 |
| Afo tib fx cast molded to pt HCPCS L2108 | not published | not published | $1,225.55 – $3,085.13 | 7 |
| Afo tib fx cast plaster mold HCPCS L2106 | not published | not published | $806.75 – $2,030.87 | 7 |
| Afo tib fx semi-rigid l2114 HCPCS L2114 | not published | not published | $607.60 – $1,529.55 | 7 |
| Afo tibial fracture rigid HCPCS L2116 | not published | not published | $780.32 – $1,964.34 | 7 |
| Afo tibial fracture soft HCPCS L2112 | not published | not published | $503.05 – $1,266.37 | 7 |
| Afo, walk boot type, cus fab HCPCS L4631 | not published | not published | $1,534.63 – $3,835.75 | 7 |
| Afo w/ankle joint, prefab HCPCS L1971 | not published | not published | $435.40 – $1,096.07 | 7 |
| After cataract laser surgery CPT 66821 | not published | not published | $296.51 – $641.17 | 9 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $11,748.33 | $11,748.33 | $210.26 – $11,043.43 | 9 |
| Ag detect nos ia single CPT 87450 | not published | not published | $4.74 – $4.74 | 1 |
| Air conduction bilat CPT 92552 | $259.60 | $259.60 | $33.07 – $218.06 | 9 |
| Air injection into abdomen 49400 CPT 49400 | $1,167.55 | $1,167.55 | $84.25 – $285.90 | 9 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $11.57 – $24.39 | 8 |
| Ak 4 bar ling w/hydraul swig HCPCS L5613 | not published | not published | $3,097.94 – $7,798.63 | 7 |
| Ak 4 bar link w/fric swing HCPCS L5611 | not published | not published | $2,036.70 – $5,127.09 | 7 |
| Ak/bk self-aligning unit ea HCPCS L5617 | not published | not published | $547.04 – $1,377.10 | 7 |
| Ak flex inner socket ext fra HCPCS L5651 | not published | not published | $1,518.09 – $3,821.56 | 7 |
| Ak/knee disartic acrylic soc HCPCS L5631 | not published | not published | $555.42 – $1,398.20 | 7 |
| Ak/knee disartic pelvic band HCPCS L5697 | not published | not published | $101.48 – $255.46 | 7 |
| Ak/knee disartic pelvic join HCPCS L5696 | not published | not published | $224.80 – $565.88 | 7 |
| Ak/knee disartic silesian ba HCPCS L5698 | not published | not published | $113.91 – $286.76 | 7 |
| Ak open end sach HCPCS L5321 | not published | not published | $3,280.87 – $8,259.11 | 7 |
| Ak pelvic control belt light HCPCS L5692 | not published | not published | $149.00 – $375.07 | 7 |
| Ak pelvic control belt pad/l HCPCS L5694 | not published | not published | $229.33 – $577.30 | 7 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | not published | not published | $174.08 – $438.21 | 7 |
| Ak univ multiplex sys frict HCPCS L5616 | not published | not published | $1,453.66 – $3,659.36 | 7 |
| Albumin body fluid quantitative each specimen CPT 82042 | $103.80 | $103.80 | $3.11 – $48.97 | 9 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $1,832.30 | $1,832.30 | $45.90 – $211.66 | 9 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $21.23 – $40.79 | 8 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $916.15 | $916.15 | $47.49 – $313.86 | 9 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $916.15 | $916.15 | $10.83 – $68.90 | 8 |
| Albumin ischemia modified CPT 82045 | not published | not published | $16.76 – $69.11 | 7 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $244.90 | $244.90 | $2.86 – $51.14 | 9 |
| Albumin serum plasma or whole blood CPT 82040 | $103.75 | $103.75 | $3.67 – $40.98 | 9 |
| Albuterol comp con HCPCS J7610 | not published | not published | $0.21 – $1.23 | 3 |
| Albuterol comp unit HCPCS J7609 | not published | not published | $0.49 – $2.79 | 4 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.13 – $0.38 | 6 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.14 – $0.31 | 6 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.03 – $0.08 | 6 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | not published | not published | $6.91 – $35.17 | 7 |
| Alcohols biomarkers 3/more CPT 80322 | not published | not published | $11.40 – $11.40 | 1 |
| Alcohol/sub misuse assess HCPCS G2011 | not published | not published | $15.89 – $33.88 | 8 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | not published | not published | $28.83 – $66.18 | 8 |
| Alcohol/subs interv >30 min HCPCS G0397 | not published | not published | $59.25 – $128.49 | 8 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $1,246.98 – $5,662.50 | 8 |
| Aldosterone suppression eval CPT 80408 | not published | not published | $61.98 – $255.54 | 7 |
| Alefacept HCPCS J0215 | not published | not published | $41.64 – $77.27 | 4 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $83,743.28 | $83,743.28 | $2,280.09 – $32,030.96 | 9 |
| Alginate dressing <=16 sq in HCPCS A6196 | not published | not published | $8.18 – $20.44 | 7 |
| Alginate drsg >16 <=48 sq in HCPCS A6197 | not published | not published | $18.27 – $45.69 | 7 |
| Alginate drsg wound filler HCPCS A6199 | not published | not published | $5.88 – $14.66 | 7 |
| Alglucerase injection HCPCS J0205 | not published | not published | $42.03 – $77.99 | 4 |
| Alglucosidase alfa injection HCPCS J0220 | $4,691.43 | $4,691.43 | $206.70 – $4,409.94 | 7 |
| Alkaline phosphatase CPT 84075 | $103.35 | $103.35 | $3.83 – $42.68 | 9 |
| Allergen alpha lactalbumin ige CPT 86008 | $109.35 | $109.35 | $17.93 – $81.87 | 9 |
| Allergen egg white ige CPT 86003 | $159.00 | $159.00 | $2.96 – $26.84 | 9 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $167.70 | $167.70 | $3.94 – $43.43 | 9 |
| Allergy injections; 2 or more 95117 CPT 95117 | not published | not published | $10.86 – $25.08 | 8 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $9.29 – $21.01 | 8 |
| Allergy Skin Testing CPT 95004 | not published | not published | $3.48 – $7.45 | 8 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $4.60 – $10.16 | 8 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $1,224.58 – $2,617.66 | 8 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | not published | not published | $17.05 – $32.76 | 6 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | not published | not published | $77.66 – $150.35 | 6 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $97.32 – $201.52 | 6 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $13,870.50 | $13,870.50 | $194.93 – $249.10 | 6 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,889.00 | $3,889.00 | $306.03 – $846.08 | 9 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $16,250.25 | $16,250.25 | $30.73 – $705.00 | 7 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $2,895.00 | $2,895.00 | $151.60 – $195.62 | 7 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $2,501.00 | $2,501.00 | $85.96 – $1,139.28 | 6 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $1,295.00 | $1,295.00 | $492.85 – $629.80 | 6 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $129.93 – $379.86 | 4 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $1,131.50 | $1,131.50 | $244.49 – $546.61 | 7 |
| Alloskin HCPCS Q4115 | not published | not published | $12.13 – $23.29 | 6 |
| Alloskin ac, 1 cm HCPCS Q4141 | not published | not published | $39.45 – $87.04 | 6 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $6.70 – $38.54 | 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.