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 |
|---|---|---|---|---|
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $1,309.05 – $2,292.36 | 6 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $10,350.00 | $10,350.00 | $149.15 – $1,645.00 | 6 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $885.38 – $1,887.67 | 8 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $12,349.00 | $12,349.00 | $31.11 – $360.02 | 6 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $762.88 – $3,274.08 | 4 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $16,250.00 | $16,250.00 | $213.51 – $299.27 | 9 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $78,422.95 | $78,422.95 | $10.66 – $26.32 | 9 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $13,181.23 | $13,181.23 | $39.06 – $1,782.47 | 7 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $5,130.00 | $5,130.00 | $103.75 – $164.34 | 7 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $1,027.98 – $2,230.64 | 8 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $3,350.00 | $3,350.00 | $135.45 – $186.68 | 7 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $1,295.00 | $1,295.00 | $40.95 – $53.49 | 7 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $162.08 – $311.33 | 4 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $14,568.00 | $14,568.00 | $2,901.94 – $3,708.30 | 6 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $894.63 | $894.63 | $97.32 – $840.94 | 7 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $17,080.00 | $17,080.00 | $13.77 – $26.79 | 9 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $4,400.00 | $4,400.00 | $49.11 – $62.75 | 6 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $1.46 – $77.95 | 4 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.30 – $0.46 | 6 |
| Granulocyte pheresis ea unit HCPCS P9050 | not published | not published | $1,345.16 – $1,345.16 | 1 |
| Great toe-hand transfer CPT 26551 | not published | not published | $3,112.26 – $6,698.69 | 8 |
| Great toe with reduction 28495 CPT 28495 | $471.00 | $471.00 | $115.84 – $290.15 | 9 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $481.01 – $1,155.15 | 9 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $486.51 – $1,184.06 | 9 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $139.83 – $369.42 | 9 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $460.73 – $981.45 | 8 |
| Ground mileage HCPCS A0425 | not published | not published | $8.94 – $18.20 | 3 |
| Group behave couns 2-10 HCPCS G0473 | not published | not published | $10.93 – $23.78 | 8 |
| Group health education CPT 99078 | not published | not published | $61.04 – $61.04 | 1 |
| Group mnt 2 or more 30 mins HCPCS G0271 | not published | not published | $14.85 – $32.13 | 8 |
| Group train without patient HCPCS G0543 | not published | not published | $10.27 – $21.69 | 6 |
| Growth hormone antibody CPT 86277 | not published | not published | $7.77 – $32.05 | 7 |
| Growth hormone panel CPT 80428 | not published | not published | $32.94 – $135.81 | 7 |
| Growth hormone panel CPT 80430 | not published | not published | $51.73 – $263.34 | 7 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $30.24 – $153.94 | 7 |
| Grp adapt bhv tx by phy/qhp CPT 97158 | not published | not published | $6.08 – $40.64 | 7 |
| Grp adapt bhv tx by tech CPT 97154 | not published | not published | $3.05 – $29.70 | 7 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $1,789.05 – $3,905.49 | 8 |
| Gstr rstcv oth/thn v-band CPT 43843 | not published | not published | $1,199.69 – $2,615.62 | 8 |
| Gstr rstcv px shrt roux-en-y CPT 43846 | not published | not published | $1,540.81 – $3,361.22 | 8 |
| Gstr rstcv px sm int rcnstj CPT 43847 | not published | not published | $1,684.16 – $3,676.38 | 8 |
| Gstr rstcv px v-banded gstp CPT 43842 | not published | not published | $1,123.03 – $2,425.21 | 6 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $662.31 – $1,436.25 | 8 |
| G-tube reposition CPT 43761 | $1,659.40 | $1,659.40 | $96.13 – $237.71 | 9 |
| Gu dilat ureter/urethra s&i CPT 74485 | $3,849.20 | $3,849.20 | $37.30 – $865.58 | 9 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,179.95 | $1,179.95 | $126.20 – $725.30 | 9 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $2,245.00 | $2,245.00 | $259.67 – $688.17 | 9 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $10,303.95 | $10,303.95 | $5.97 – $9.12 | 9 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $2,110.00 | $2,110.00 | $19.86 – $25.38 | 6 |
| Guid loc target vol rad tx CPT 77387 | $350.15 | $350.15 | $37.52 – $329.14 | 7 |
| Gum graft CPT 41870 | not published | not published | $372.20 – $1,476.65 | 7 |
| Gw stiffened micro access kit HCPCS C1894 | $23,737.80 | $23,737.80 | $7.61 – $15.56 | 9 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $414.46 – $1,118.53 | 9 |
| Hair analysis HCPCS P2031 | not published | not published | $4.95 – $10.08 | 7 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $81.40 – $610.22 | 7 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $241.91 – $725.99 | 9 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $330.48 – $981.69 | 9 |
| Hallus-valgus nt dyn pre ots HCPCS L3100 | not published | not published | $40.17 – $101.10 | 7 |
| Halo cervical into body jack HCPCS L0820 | not published | not published | $2,563.01 – $6,452.01 | 7 |
| Halo cervical into jckt vest HCPCS L0810 | not published | not published | $3,009.62 – $7,576.27 | 7 |
| Halo cerv into milwaukee typ HCPCS L0830 | not published | not published | $3,333.28 – $8,391.06 | 7 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $125.59 | $125.59 | $6.53 – $9.43 | 7 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $23.22 | $23.22 | $1.16 – $6.58 | 9 |
| Halo repl liner/interface HCPCS L0861 | not published | not published | $200.21 – $504.00 | 7 |
| Hand-held pefr meter a4614 HCPCS A4614 | not published | not published | $26.44 – $66.07 | 7 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | not published | not published | $7.25 – $10.85 | 4 |
| Hand orthosis metacarpal fracture orthosis prefa l3918 HCPCS L3918 | not published | not published | $89.34 – $224.92 | 7 |
| Hand restoration multiple fi HCPCS L6905 | not published | not published | $1,391.98 – $3,504.12 | 7 |
| Hand restoration no fingers HCPCS L6910 | not published | not published | $1,356.07 – $3,413.71 | 7 |
| Hand restoration replacmnt g HCPCS L6915 | not published | not published | $637.18 – $1,604.02 | 7 |
| Hand restorat thumb/1 finger HCPCS L6900 | not published | not published | $1,432.04 – $3,604.95 | 7 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $220.25 | $220.25 | $26.66 – $81.51 | 9 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $812.51 – $1,731.77 | 8 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $642.09 – $1,413.20 | 8 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $729.19 – $1,551.48 | 8 |
| Hand X-ray CPT 73130 | $293.05 | $293.05 | $8.00 – $165.61 | 9 |
| Hand X-ray (2 views, both hands) CPT 73120 | $256.45 | $256.45 | $7.68 – $127.09 | 9 |
| Haptoglobin quantitative CPT 83010 | $185.95 | $185.95 | $6.21 – $92.83 | 9 |
| Harness chest/shlder saddle HCPCS L6672 | not published | not published | $159.86 – $402.43 | 7 |
| Harness figure of 8 dual con HCPCS L6676 | not published | not published | $120.27 – $302.76 | 7 |
| Harness figure of 8 sing con HCPCS L6675 | not published | not published | $151.81 – $382.15 | 7 |
| Harvest allogeneic stem cell CPT 38205 | not published | not published | $79.45 – $168.10 | 8 |
| Harvest auto stem cells CPT 38206 | not published | not published | $78.14 – $165.38 | 8 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $118.43 – $503.69 | 9 |
| Harvest eye tissue alograft CPT 68371 | not published | not published | $392.19 – $830.30 | 8 |
| Harvest femoropopliteal vein 35572 CPT 35572 | not published | not published | $306.68 – $678.48 | 8 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $46.00 – $435.81 | 7 |
| Harvest vein for bypass 35500 CPT 35500 | not published | not published | $283.53 – $629.00 | 8 |
| Hast w/i&r phys/qhp CPT 94452 | $187.15 | $187.15 | $13.51 – $157.21 | 9 |
| Hast w/oxygen titrate CPT 94453 | $187.15 | $187.15 | $17.29 – $157.21 | 9 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $600.00 – $1,221.72 | 7 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $443.10 | $443.10 | $202.40 – $416.51 | 9 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $375.25 – $764.08 | 7 |
| Hbb full gene sequence CPT 81364 | not published | not published | $324.58 – $660.91 | 7 |
| Hbb gene com variants CPT 81361 | $1,410.15 | $1,410.15 | $24.64 – $180.05 | 9 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $202.40 – $412.13 | 7 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $375.25 – $764.08 | 7 |
| Hb glycosylated a1c home dev CPT 83037 | not published | not published | $7.19 – $19.77 | 7 |
| Hbot, full body chamber, 30m HCPCS G0277 | $841.20 | $841.20 | $74.25 – $188.80 | 9 |
| Hc ea ha check monaural CPT 92594 | not published | not published | $21.94 – $43.37 | 4 |
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.