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 |
|---|---|---|---|---|
| Ghs fish cytogen CPT 88271 | $265.10 | $265.10 | $12.13 – $202.05 | 9 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $230.20 | $230.20 | $22.75 – $95.50 | 9 |
| Ghs flow volume loop CPT 94375 | not published | not published | $13.51 – $28.47 | 8 |
| Ghs gastric intub aspiration lavage CPT 43753 | $530.25 | $530.25 | $19.97 – $43.37 | 9 |
| Ghs hcv amplificaiton CPT 87521 | not published | not published | $17.33 – $71.45 | 7 |
| Ghs heavy metals bld (ars,lead,merc) CPT 82715 | not published | not published | $9.19 – $48.13 | 7 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | not published | not published | $7.65 – $31.54 | 7 |
| Ghs hgb stability-thal CPT 83068 | $19.80 | $19.80 | $4.18 – $18.61 | 9 |
| Ghs histoplasma antigen CPT 87385 | $178.15 | $178.15 | $5.92 – $27.26 | 9 |
| Ghs HIV antibody CPT 86703 | $135.80 | $135.80 | $6.77 – $74.17 | 9 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $42.46 – $216.12 | 7 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | $4,012.50 | $4,012.50 | $153.85 – $434.46 | 9 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $3,696.80 | $3,696.80 | $143.68 – $397.24 | 9 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $3,119.35 | $3,119.35 | $162.84 – $459.06 | 9 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $1,224.75 | $1,224.75 | $82.74 – $204.90 | 9 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $11.97 – $35.25 | 8 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $885.75 | $885.75 | $96.53 – $239.04 | 9 |
| Ghs indirect laryngoscopy/w fb removal CPT 31511 | $338.20 | $338.20 | $127.63 – $284.09 | 9 |
| Ghs inf midline insertion CPT 36140 | $1,930.20 | $1,930.20 | $80.28 – $848.44 | 9 |
| Ghs inhibitor screen CPT 85335 | $385.80 | $385.80 | $6.36 – $89.49 | 9 |
| Ghs init tx 1st degree burn CPT 16000 | $368.40 | $368.40 | $42.77 – $89.98 | 9 |
| Ghs inj neurolytic intercostal nerve CPT 64620 | $379.80 | $379.80 | $170.96 – $331.15 | 9 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $1,651.70 | $1,651.70 | $114.32 – $448.64 | 9 |
| Ghs inj tendon origin/insertion CPT 20551 | $697.25 | $697.25 | $36.43 – $111.14 | 9 |
| Ghs inj transforaminal cerv ea add bil CPT 64480 | $2,071.80 | $2,071.80 | $58.38 – $209.83 | 9 |
| Ghs inj transforaminal cerv single bil CPT 64479 | $2,071.80 | $2,071.80 | $125.01 – $512.68 | 9 |
| Ghs insertion of needle - bone CPT 36680 | $409.45 | $409.45 | $55.38 – $119.97 | 9 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $1,104.60 | $1,104.60 | $150.79 – $265.88 | 9 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $1,046.70 | $1,046.70 | $179.61 – $495.10 | 9 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $1,525.10 | $1,525.10 | $309.83 – $941.85 | 9 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | not published | not published | $8.86 – $59.75 | 7 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $554.15 | $554.15 | $126.49 – $326.91 | 9 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $130.85 | $130.85 | $17.50 – $107.18 | 9 |
| Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 | not published | not published | $432.38 – $916.29 | 6 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | not published | not published | $432.38 – $916.29 | 6 |
| Ghs IV infusion sotrovimab HCPCS M0247 | not published | not published | $432.38 – $916.29 | 6 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $3,292.15 | $3,292.15 | $233.10 – $608.32 | 9 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $893.60 | $893.60 | $44.93 – $124.22 | 9 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $559.30 | $559.30 | $52.51 – $145.18 | 9 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $599.55 | $599.55 | $52.51 – $145.18 | 9 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $680.20 | $680.20 | $52.51 – $145.18 | 9 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $738.10 | $738.10 | $150.79 – $327.17 | 9 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $760.40 | $760.40 | $150.79 – $373.43 | 9 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $751.50 | $751.50 | $150.79 – $287.55 | 9 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $859.00 | $859.00 | $150.79 – $369.28 | 9 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $889.05 | $889.05 | $169.08 – $407.65 | 9 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $954.75 | $954.75 | $150.79 – $407.44 | 9 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $908.75 | $908.75 | $260.35 – $495.10 | 9 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $1,232.25 | $1,232.25 | $150.79 – $416.89 | 9 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $1,281.85 | $1,281.85 | $301.23 – $495.10 | 9 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $1,561.45 | $1,561.45 | $367.69 – $495.10 | 9 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | $1,525.10 | $1,525.10 | $333.18 – $986.82 | 9 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $1,770.70 | $1,770.70 | $386.68 – $1,121.86 | 9 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | not published | not published | $4.25 – $17.51 | 7 |
| Ghs low level laser therapy CPT 97039 | not published | not published | $27.79 – $27.79 | 1 |
| Ghs mbp CPT 83873 | $154.40 | $154.40 | $8.50 – $48.93 | 9 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $273.00 | $273.00 | $22.70 – $116.93 | 9 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $293.60 | $293.60 | $77.37 – $166.05 | 9 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $307.30 | $307.30 | $30.73 – $92.21 | 9 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $168.55 | $168.55 | $10.15 – $23.72 | 9 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $178.10 | $178.10 | $25.83 – $98.37 | 9 |
| Ghs musc test done w/n test comp CPT 95886 | $147.00 | $147.00 | $42.86 – $123.48 | 9 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $327.30 | $327.30 | $17.43 – $274.93 | 9 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $261.35 | $261.35 | $35.06 – $219.53 | 9 |
| Ghs myocardial strain img spckl track CPT 93356 | $793.95 | $793.95 | $11.13 – $69.99 | 9 |
| Ghs nailbed repair/nail removal CPT 11760 | $526.70 | $526.70 | $50.27 – $138.98 | 9 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,919.50 | $1,919.50 | $23.24 – $64.25 | 9 |
| Ghs nerve blk intercostal, single level CPT 64420 | $1,219.95 | $1,219.95 | $55.81 – $188.88 | 9 |
| Ghs nerve block axillary nerve CPT 64417 | $1,224.80 | $1,224.80 | $61.17 – $206.85 | 9 |
| Ghs nerve block brachial plexus CPT 64415 | $1,461.40 | $1,461.40 | $66.01 – $258.28 | 9 |
| Ghs nerve block celiac plexus CPT 64530 | $1,144.70 | $1,144.70 | $90.51 – $422.42 | 9 |
| Ghs nerve block interscaline CPT 64510 | $2,132.95 | $2,132.95 | $73.11 – $223.13 | 9 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $2,132.95 | $2,132.95 | $81.27 – $444.59 | 9 |
| Ghs nerve block sciatic nerve CPT 64445 | $1,683.90 | $1,683.90 | $68.32 – $305.81 | 9 |
| Ghs nerve block suprascapular CPT 64418 | $1,027.90 | $1,027.90 | $52.42 – $166.40 | 9 |
| Ghs ng placement w fluoro guidance CPT 43752 | $572.65 | $572.65 | $37.49 – $79.98 | 9 |
| Ghs o2 saturation CPT 82810 | $112.00 | $112.00 | $4.31 – $46.01 | 9 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $11.78 – $25.08 | 8 |
| Ghs o2 uptake rest & indirect CPT 94690 | $510.95 | $510.95 | $3.46 – $7.45 | 9 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | $7,279.30 | $7,279.30 | $41.49 – $53.02 | 9 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,367.25 | $1,367.25 | $31.34 – $274.97 | 9 |
| Ghs opcc repair cvp w subq port CPT 36576 | $2,255.65 | $2,255.65 | $170.58 – $656.59 | 9 |
| Ghs optokenetic CPT 92544 | not published | not published | $3.49 – $26.98 | 8 |
| Ghs oscillating trac CPT 92545 | not published | not published | $3.49 – $25.05 | 8 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $77.50 | $77.50 | $21.74 – $51.79 | 9 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | $107.60 | $107.60 | $24.49 – $31.96 | 9 |
| Ghs ot dds rom CPT 95851 | $190.35 | $190.35 | $7.35 – $41.76 | 9 |
| Ghs ot group caregiver training CPT 97552 | $16.60 | $16.60 | $5.61 – $15.51 | 9 |
| Ghs ot prosthetic training/15 min CPT 97761 | $149.15 | $149.15 | $40.61 – $79.40 | 9 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $112.80 | $112.80 | $48.06 – $70.27 | 9 |
| Ghs ot work hardening-additional hours CPT 97546 | $246.05 | $246.05 | $59.26 – $231.29 | 7 |
| Ghs pacing - transcutaneous CPT 92953 | $664.60 | $664.60 | $0.86 – $47.48 | 9 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $853.65 | $853.65 | $56.76 – $188.24 | 9 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $340.55 | $340.55 | $48.77 – $175.39 | 9 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | not published | not published | $22.04 – $48.81 | 8 |
| Ghs peritonsillar abscess i andd CPT 42700 | $739.55 | $739.55 | $131.23 – $339.33 | 9 |
| Ghs phenylketonurid CPT 84030 | $250.15 | $250.15 | $2.72 – $63.92 | 9 |
| Ghs picc line insert < 5 CPT 36568 | $2,585.25 | $2,585.25 | $86.00 – $2,171.61 | 9 |
| Ghs plngl fx pm cl CPT 26725 | $898.45 | $898.45 | $133.43 – $274.72 | 9 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $2.13 – $8.78 | 7 |
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.