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 polysom <6 yrs 4/> parameters CPT 95782 | not published | not published | $116.36 – $244.68 | 8 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $3.81 – $46.90 | 8 |
| Ghs ppd (tb intradermal) CPT 86580 | $112.21 | $112.21 | $9.29 – $33.01 | 9 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $85.05 | $85.05 | $4.77 – $64.16 | 9 |
| Ghs protein, misc fluid CPT 84160 | not published | not published | $2.56 – $11.42 | 7 |
| Ghs protoporphyrins fract CPT 84202 | $220.90 | $220.90 | $7.08 – $99.03 | 9 |
| Ghs pr without cont pulse ox CPT 94625 | $360.25 | $360.25 | $16.47 – $117.32 | 9 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $6.05 – $24.94 | 7 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $406.50 | $406.50 | $148.84 – $382.11 | 7 |
| Ghs quinidine CPT 80194 | $227.05 | $227.05 | $7.21 – $175.50 | 9 |
| Ghs refill of implantable pump CPT 95990 | $584.55 | $584.55 | $83.49 – $491.02 | 9 |
| Ghs removal intranasal foreign body CPT 30300 | $612.25 | $612.25 | $27.57 – $76.23 | 9 |
| Ghs removal pharyngeal foreign body CPT 42809 | $388.85 | $388.85 | $120.98 – $284.30 | 9 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $3,017.95 | $3,017.95 | $565.08 – $1,231.57 | 9 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $5,376.45 | $5,376.45 | $444.73 – $1,027.55 | 9 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $57.45 | $57.45 | $6.36 – $41.41 | 9 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $2.13 – $8.78 | 7 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $175.80 | $175.80 | $5.92 – $107.40 | 9 |
| Ghs sedimentation rate CPT 85651 | $69.05 | $69.05 | $2.63 – $20.40 | 9 |
| Ghs semen analysis fert CPT 89320 | $284.15 | $284.15 | $5.95 – $142.69 | 9 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $4.41 – $20.04 | 7 |
| Ghs sensitivity (per antimicro) CPT 87184 | $226.80 | $226.80 | $3.40 – $38.35 | 9 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $721.80 | $721.80 | $52.51 – $145.18 | 9 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $1,162.30 | $1,162.30 | $52.51 – $145.18 | 9 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $562.25 | $562.25 | $107.56 – $214.53 | 9 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $526.70 | $526.70 | $115.70 – $311.78 | 9 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $686.80 | $686.80 | $52.51 – $134.98 | 9 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $658.95 | $658.95 | $52.51 – $118.49 | 9 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $843.90 | $843.90 | $52.51 – $145.18 | 9 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $497.75 | $497.75 | $102.15 – $259.96 | 9 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $721.05 | $721.05 | $160.28 – $605.68 | 9 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $36.97 – $77.95 | 8 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,662.55 | $1,662.55 | $25.09 – $633.74 | 9 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,662.55 | $1,662.55 | $42.74 – $833.74 | 9 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $162.50 | $162.50 | $47.48 – $98.35 | 9 |
| Ghs sphenopalatine ganglion block CPT 64505 | $806.10 | $806.10 | $98.59 – $280.76 | 9 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $4.14 – $39.83 | 8 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $448.75 | $448.75 | $75.91 – $104.12 | 9 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $10.28 – $31.48 | 9 |
| Ghs strapping shoulder - 29240 CPT 29240 | $290.80 | $290.80 | $17.08 – $57.18 | 9 |
| Ghs st - re-eval for alt comm CPT 92597 | $547.95 | $547.95 | $70.73 – $460.28 | 9 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $14.89 – $32.54 | 8 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $131.09 – $281.29 | 8 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,412.45 | $1,412.45 | $146.76 – $363.45 | 9 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $634.25 | $634.25 | $134.93 – $343.72 | 9 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $805.95 | $805.95 | $274.02 – $644.58 | 9 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $3.60 – $14.86 | 7 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $900.90 | $900.90 | $68.20 – $188.56 | 9 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $1,561.45 | $1,561.45 | $226.94 – $416.94 | 9 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $12.00 – $50.84 | 7 |
| Ghs urine, porphyrins quant CPT 84120 | $331.10 | $331.10 | $7.26 – $78.82 | 9 |
| Ghs vaginal delivery only CPT 59409 | $2,186.00 | $2,186.00 | $735.28 – $1,626.04 | 9 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $967.10 | $967.10 | $513.54 – $805.11 | 9 |
| Ghs windowing of cast CPT 29730 | not published | not published | $42.08 – $127.20 | 9 |
| Giardia ag if CPT 87269 | not published | not published | $5.92 – $27.71 | 7 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $7.27 – $29.97 | 7 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $38.62 – $81.34 | 8 |
| Gi inhouse confirmation CPT 87045 | $198.45 | $198.45 | $4.66 – $111.91 | 9 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $290.03 – $912.94 | 9 |
| Gi protein loss CPT 78282 | not published | not published | $14.47 – $30.50 | 8 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,206.10 | $2,206.10 | $106.46 – $1,853.12 | 9 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $114.79 – $241.29 | 8 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $42.84 – $90.14 | 8 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $99.86 – $210.11 | 8 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $40.45 – $205.90 | 7 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $24.61 – $125.27 | 7 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $14.00 – $71.27 | 7 |
| Glassia injection HCPCS J0257 | not published | not published | $5.25 – $10.36 | 8 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $23.70 – $128.09 | 8 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $37.99 – $84.05 | 8 |
| Glaucoma surgery CPT 66150 | not published | not published | $836.18 – $1,763.64 | 8 |
| Glaucoma surgery CPT 66155 | not published | not published | $835.51 – $1,762.28 | 8 |
| Glaucoma surgery CPT 66160 | not published | not published | $940.53 – $1,980.52 | 8 |
| Glaucoma surgery CPT 66170 | not published | not published | $1,042.79 – $2,199.45 | 8 |
| Glove finger flexion right lg xl HCPCS L3912 | not published | not published | $82.58 – $207.90 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $2,438.99 | $2,438.99 | $188.37 – $855.35 | 9 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $2,572.14 | $2,572.14 | $123.83 – $593.61 | 9 |
| Glucagon plasma - sendout CPT 82943 | $308.45 | $308.45 | $7.06 – $120.18 | 9 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $22.75 – $93.81 | 7 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $24.94 – $102.83 | 7 |
| Glucagon tolerance test CPT 82946 | not published | not published | $7.44 – $36.18 | 7 |
| Glucose 1 hr post dose CPT 82950 | $115.75 | $115.75 | $3.52 – $57.76 | 9 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $2.99 – $12.32 | 7 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $32.70 | $32.70 | $1.97 – $6.77 | 9 |
| Glucose blood quantitative CPT 82947 | $102.90 | $102.90 | $1.94 – $37.41 | 9 |
| Glucose body fluid CPT 82945 | $103.70 | $103.70 | $1.94 – $46.72 | 9 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $56.58 – $132.84 | 8 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $288.60 | $288.60 | $9.53 – $117.55 | 9 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $103.80 | $103.80 | $2.90 – $46.72 | 9 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $37.16 | $37.16 | $0.43 – $24.88 | 9 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $27.79 – $30.15 | 4 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $7,174.15 | $7,174.15 | $11.03 – $6,743.70 | 9 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $582.55 | $582.55 | $13.76 – $76.33 | 9 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $73.29 – $302.19 | 7 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $547.60 | $547.60 | $13.72 – $76.33 | 9 |
| Gonioscopy CPT 92020 | not published | not published | $19.38 – $52.69 | 9 |
| Goniotomy CPT 65820 | not published | not published | $784.05 – $1,647.05 | 8 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $10,478.50 | $10,478.50 | $572.82 – $3,546.57 | 9 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $1,295.00 | $1,295.00 | $30.40 – $57.65 | 7 |
| Graft axiofill 1000mg HCPCS J3590 | $757.80 | $757.80 | $334.33 – $427.23 | 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.