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 |
|---|---|---|---|---|
| Flutemetamol f18 diagnostic HCPCS Q9982 | not published | not published | $1,866.58 – $6,719.46 | 8 |
| Fluvirin vacc, 3 yrs & >, im HCPCS Q2037 | not published | not published | $17.52 – $25.08 | 3 |
| Fluzone vacc, 3 yrs & >, im HCPCS Q2038 | $21.55 | $21.55 | $11.97 – $120.69 | 6 |
| Fmri brain by phys/psych CPT 70555 | $1,848.60 | $1,848.60 | $113.07 – $1,552.82 | 9 |
| Fmri brain by tech CPT 70554 | $468.55 | $468.55 | $96.22 – $393.58 | 9 |
| Fna bx w/ct gdn 1st les CPT 10009 | $2,398.05 | $2,398.05 | $101.67 – $659.95 | 9 |
| Fna bx w/ct gdn ea addl CPT 10010 | $785.65 | $785.65 | $67.32 – $436.76 | 9 |
| Fna bx w/mr gdn 1st les CPT 10011 | $2,655.00 | $2,655.00 | $142.41 – $1,048.10 | 9 |
| Fna bx w/mr gdn ea addl CPT 10012 | $785.65 | $785.65 | $104.08 – $640.23 | 7 |
| Foam drg >16<=48 sq in w/bdr HCPCS A6213 | not published | not published | $9.53 – $29.14 | 3 |
| Foam drg >16<=48 sq in without b HCPCS A6210 | $83.00 | $83.00 | $22.15 – $78.02 | 9 |
| Foam drg <=16 sq in w/border HCPCS A6212 | not published | not published | $10.80 – $26.98 | 7 |
| Foam drg > 48 sq in w/border HCPCS A6214 | not published | not published | $11.44 – $28.61 | 7 |
| Foam drg > 48 sq in without brdr HCPCS A6211 | not published | not published | $32.65 – $81.61 | 7 |
| Foam drsg <=16 sq in without bdr HCPCS A6209 | not published | not published | $8.31 – $20.77 | 7 |
| Foam/fabric leg strap HCPCS A5114 | not published | not published | $8.46 – $21.14 | 7 |
| Foam stability fetal lung CPT 83662 | not published | not published | $9.34 – $38.50 | 7 |
| Folic acid CPT 82746 | $185.75 | $185.75 | $7.26 – $72.85 | 9 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $5.21 | $5.21 | $0.94 – $2.59 | 9 |
| Follow-up angiography CPT 75898 | $1,464.30 | $1,464.30 | $46.19 – $396.14 | 9 |
| Followup eval of foot pt lop HCPCS G0246 | not published | not published | $18.91 – $75.17 | 8 |
| Follow-up surgery of eye CPT 66250 | not published | not published | $530.25 – $1,441.70 | 9 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $4,683.83 | $4,683.83 | $6.03 – $3,514.11 | 9 |
| Fondaparinux sodium HCPCS J1652 | $562.93 | $562.93 | $1.08 – $125.10 | 7 |
| Fo nontorsion joint cf HCPCS L3935 | not published | not published | $186.75 – $470.12 | 7 |
| Foot arch support remov prem HCPCS L3030 | not published | not published | $70.90 – $178.47 | 7 |
| Foot arch supp premold metat HCPCS L3050 | not published | not published | $43.71 – $110.04 | 7 |
| Foot drp splt w/exp heel lg HCPCS L4398 | not published | not published | $74.97 – $188.74 | 7 |
| Foot external keel sach foot HCPCS L5970 | not published | not published | $256.73 – $646.29 | 7 |
| Foot insert plastazote or eq HCPCS L3002 | not published | not published | $150.02 – $377.67 | 7 |
| Foot insert remov molded spe HCPCS L3001 | not published | not published | $122.86 – $309.30 | 7 |
| Foot insert silicone gel eac HCPCS L3003 | not published | not published | $161.89 – $407.53 | 7 |
| Foot lamin/prepreg composite HCPCS L3031 | not published | not published | $113.78 – $286.41 | 7 |
| Foot longitudinal arch suppo HCPCS L3010 | not published | not published | $161.89 – $407.53 | 7 |
| Foot longitud/metatarsal sup HCPCS L3020 | not published | not published | $184.29 – $463.91 | 7 |
| Foot plas heel stabi pre ots HCPCS L3170 | not published | not published | $47.27 – $119.00 | 7 |
| Foot plate molded stirrup at HCPCS L2250 | not published | not published | $316.21 – $796.01 | 7 |
| Foot single axis ankle/foot HCPCS L5974 | not published | not published | $288.03 – $725.07 | 7 |
| Foot X-ray CPT 73630 | $382.00 | $382.00 | $7.68 – $246.16 | 9 |
| Foot X-ray (2 views, both feet) CPT 73620 | $346.60 | $346.60 | $7.02 – $233.53 | 9 |
| Forearm/arm cuffs ext/flex a HCPCS L3730 | not published | not published | $1,046.65 – $2,634.82 | 7 |
| Forearm/arm cuffs free motio HCPCS L3720 | not published | not published | $569.57 – $1,433.83 | 7 |
| Forearm X-ray (both sides) CPT 73090 | $393.95 | $393.95 | $7.35 – $139.31 | 9 |
| Forehead flap w/vasc pedicle 15731 CPT 15731 | not published | not published | $954.65 – $2,169.60 | 9 |
| Forensic autopsy (necropsy) CPT 88040 | not published | not published | $247.68 – $1,182.77 | 4 |
| Forensic cytopathology CPT 88125 | not published | not published | $12.88 – $27.11 | 8 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $554.15 | $554.15 | $20.28 – $56.07 | 9 |
| Formoterol comp unit HCPCS J7640 | not published | not published | $1.73 – $2.49 | 3 |
| Formoterol fumarate, inh HCPCS J7606 | not published | not published | $3.15 – $5.73 | 6 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $3,406.34 | $3,406.34 | $0.14 – $498.15 | 9 |
| Foscarnet sodium injection HCPCS J1455 | $4,812.32 | $4,812.32 | $15.58 – $4,523.58 | 9 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $504.79 | $504.79 | $2.55 – $112.10 | 9 |
| Fractionation ketosteroids CPT 83593 | not published | not published | $12.99 – $58.03 | 7 |
| Fracture assessment via dxa CPT 77086 | $133.45 | $133.45 | $7.68 – $112.36 | 9 |
| _fragile x methylation-sendout CPT 81244 | not published | not published | $17.96 – $91.41 | 7 |
| Fragmenting of kidney stone CPT 50590 | not published | not published | $547.41 – $1,430.14 | 9 |
| Frame typ sock above elb/dis HCPCS L6688 | not published | not published | $530.77 – $1,336.15 | 7 |
| Frame typ socket bel elbow/w HCPCS L6687 | not published | not published | $546.87 – $1,376.65 | 7 |
| Frame typ socket shoulder di HCPCS L6689 | not published | not published | $652.77 – $1,643.23 | 7 |
| Frame typ sock interscap-tho HCPCS L6690 | not published | not published | $684.59 – $1,723.36 | 7 |
| Free fascial flap microvasc CPT 15758 | not published | not published | $2,137.25 – $4,574.47 | 8 |
| Freeing of bowel adhesion 44005 CPT 44005 | not published | not published | $1,018.58 – $2,217.08 | 8 |
| Free jejunum flap microvasc CPT 43496 | not published | not published | $2,142.68 – $4,293.32 | 8 |
| Free myo/skin flap microvasc CPT 15756 | not published | not published | $2,157.58 – $4,623.95 | 8 |
| Free omental flap microvasc CPT 49906 | not published | not published | $3,185.75 – $4,893.02 | 3 |
| Free/remove chest lining 32320 CPT 32320 | not published | not published | $1,476.85 – $3,223.61 | 8 |
| Free skin flap microvasc CPT 15757 | not published | not published | $2,145.31 – $4,593.44 | 8 |
| Frenectomy 41115 CPT 41115 | not published | not published | $141.11 – $505.62 | 9 |
| Frenotomy 40806 CPT 40806 | not published | not published | $27.57 – $192.74 | 9 |
| Frenulotomy of penis CPT 54164 | not published | not published | $186.14 – $397.87 | 8 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $711.80 | $711.80 | $71.09 – $148.24 | 9 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $711.80 | $711.80 | $84.29 – $293.94 | 9 |
| Fresh frozen plasma thawing ea un CPT 86927 | not published | not published | $8.35 – $170.82 | 7 |
| Fr frz plasma donor retested HCPCS P9060 | not published | not published | $48.93 – $50.40 | 5 |
| Frozen blood freeze/thaw CPT 86932 | not published | not published | $37.99 – $145.72 | 7 |
| Frozen blood prep CPT 86930 | not published | not published | $49.39 – $171.49 | 7 |
| Frozen blood thaw CPT 86931 | not published | not published | $37.01 – $170.82 | 7 |
| Frozen cell preparation CPT 88241 | not published | not published | $5.72 – $24.62 | 7 |
| Frozen plasma, pooled, sd HCPCS P9023 | not published | not published | $62.31 – $133.92 | 6 |
| Fructosamine glycated protein CPT 82985 | $167.00 | $167.00 | $11.17 – $90.01 | 9 |
| Ft arch suprt premold longit HCPCS L3040 | not published | not published | $43.71 – $110.04 | 7 |
| Fth/gft fr n/e/e/l each addl CPT 15261 | not published | not published | $127.26 – $394.47 | 9 |
| Fth/gft fr trnk each addl CPT 15201 | not published | not published | $71.24 – $269.20 | 9 |
| Ft insert ucb berkeley shell HCPCS L3000 | not published | not published | $291.80 – $734.56 | 7 |
| Ftl cgen abnor 3 proteins CPT 81509 | $2,712.50 | $2,712.50 | $594.95 – $2,399.77 | 9 |
| Ftl cgen abnor five anal CPT 81512 | not published | not published | $27.81 – $141.56 | 7 |
| Ftl cgen abnor four anal CPT 81511 | $460.80 | $460.80 | $61.40 – $219.44 | 9 |
| Ftl cgen abnor three anal CPT 81510 | not published | not published | $22.22 – $113.09 | 7 |
| Ftl cgen abnor two proteins CPT 81508 | $230.10 | $230.10 | $21.72 – $203.60 | 9 |
| Ft prosth multiaxial ankl/ft HCPCS L5978 | not published | not published | $352.14 – $886.44 | 7 |
| Full field erg w/i&r CPT 92273 | not published | not published | $33.99 – $71.16 | 8 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $10.60 – $21.69 | 8 |
| Full sole/heel wedge btween HCPCS L3420 | not published | not published | $50.82 – $127.91 | 7 |
| Full Spine X-ray (Scoliosis Survey) CPT 72082 | $708.20 | $708.20 | $14.38 – $225.82 | 9 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | not published | not published | $811.93 – $1,934.46 | 9 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | $3,406.20 | $3,406.20 | $584.08 – $1,491.16 | 9 |
| Full thick gft/scalp/arm/leg/add 20sqcm 15221 CPT 15221 | $3,791.85 | $3,791.85 | $64.55 – $248.63 | 9 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | $3,194.80 | $3,194.80 | $761.87 – $1,799.54 | 9 |
| Functional brain mapping CPT 96020 | not published | not published | $148.83 – $313.15 | 8 |
| Fundus photography with i&r 92250 CPT 92250 | not published | not published | $15.92 – $39.20 | 8 |
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.