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 |
|---|---|---|---|---|
| Inj delandistrogene mox rokl HCPCS J1413 | not published | not published | $0.02 – $6,515,840.00 | 6 |
| Inj. denosumab-bbdz, 1 mg HCPCS Q5136 | not published | not published | $27.54 – $28.36 | 5 |
| Inj diclofenac sodium 0.5mg HCPCS J1130 | not published | not published | $0.21 – $0.41 | 3 |
| Inj disk cerv-thor ea lev CPT 62291 | $664.60 | $664.60 | $135.23 – $558.26 | 9 |
| Inj, docetaxel (beizray) 1mg HCPCS J9174 | not published | not published | $52.47 – $54.04 | 5 |
| Inj, donanemab-azbt, 2 mg HCPCS J0175 | not published | not published | $4.14 – $8.09 | 6 |
| Inj dupuytren cord w/enzyme CPT 20527 | not published | not published | $62.68 – $169.62 | 9 |
| Inj, durolane 1 mg HCPCS J7318 | not published | not published | $6.14 – $12.58 | 8 |
| Inj dx for sinogram CPT 20501 | $886.95 | $886.95 | $34.04 – $271.77 | 9 |
| Inject for sacroiliac joint HCPCS G0259 | $215.10 | $215.10 | $158.23 – $202.19 | 6 |
| Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 | not published | not published | $78.54 – $427.88 | 9 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $1,730.85 | $1,730.85 | $64.10 – $443.30 | 9 |
| Injection, belinostat, 10mg HCPCS J9032 | not published | not published | $48.06 – $93.81 | 8 |
| Injection, burosumab-twza 1m HCPCS J0584 | $17,869.09 | $17,869.09 | $423.00 – $7,896.14 | 9 |
| Injection, cangrelor HCPCS C9460 | $4,699.52 | $4,699.52 | $19.47 – $4,417.55 | 9 |
| Injection, caplacizumab-yhdp HCPCS C9047 | not published | not published | $764.26 – $1,525.66 | 3 |
| Injection carpal tunnel therapeutic (both sides) CPT 20526 | $787.15 | $787.15 | $53.77 – $159.33 | 9 |
| Injection, casimersen, 10 mg HCPCS J1426 | $5,317.84 | $5,317.84 | $163.20 – $4,998.77 | 7 |
| Injection, cimetidine hydroc HCPCS S0023 | not published | not published | $2.44 – $4.70 | 3 |
| Injection, daratumumab 10 mg HCPCS J9145 | $6,869.31 | $6,869.31 | $61.71 – $4,198.60 | 9 |
| Injection, delafloxacin HCPCS C9462 | not published | not published | $0.48 – $0.96 | 2 |
| Injection, doxercalciferol HCPCS J1270 | not published | not published | $0.33 – $0.75 | 6 |
| Injection during cath supravalvular aortography CPT 93567 | $940.35 | $940.35 | $33.89 – $159.89 | 9 |
| Injection, edaravone, 1 mg HCPCS J1301 | $4,335.74 | $4,335.74 | $18.84 – $4,075.60 | 9 |
| Injection epidural blood patch or clot CPT 62273 | $1,165.05 | $1,165.05 | $68.92 – $190.54 | 9 |
| Injection estrone per 1 mg HCPCS J1435 | not published | not published | $0.08 – $0.67 | 4 |
| Injection eye drug CPT 67028 | not published | not published | $87.75 – $216.52 | 9 |
| Injection, famotidine, 20 mg HCPCS S0028 | not published | not published | $0.92 – $3.38 | 3 |
| Injection for arthrography wrist (both sides) CPT 25246 | $793.95 | $793.95 | $59.62 – $147.64 | 9 |
| Injection for bladder x-ray CPT 51600 | $1,265.65 | $1,265.65 | $35.17 – $87.10 | 9 |
| Injection for hip x-ray CPT 27095 | $2,319.65 | $2,319.65 | $76.76 – $588.50 | 9 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $1,244.20 | $1,244.20 | $46.91 – $311.60 | 9 |
| Injection for spleen x-ray CPT 38200 | not published | not published | $122.03 – $258.92 | 8 |
| Injection for tear sac x-ray CPT 68850 | not published | not published | $49.41 – $111.78 | 9 |
| Injection for ureter x-ray CPT 50684 | $606.10 | $606.10 | $48.54 – $245.43 | 9 |
| Injection for ureter x-ray CPT 50690 | $636.45 | $636.45 | $67.12 – $228.08 | 9 |
| Injection, fosphenytoin sodi HCPCS S0078 | not published | not published | $38.25 – $266.37 | 3 |
| Injection, fulvestrant HCPCS J9395 | $4,666.82 | $4,666.82 | $6.98 – $4,386.81 | 9 |
| Injection glatiramer acetate HCPCS J1595 | not published | not published | $58.65 – $3,253.44 | 8 |
| Injection, glucarpidase HCPCS C9293 | not published | not published | $392.50 – $783.53 | 2 |
| Injection, inclisiran, 1 mg HCPCS J1306 | not published | not published | $12.13 – $23.27 | 8 |
| Injection into brain canal CPT 61026 | not published | not published | $101.83 – $224.35 | 8 |
| Injection into brain canal CPT 61055 | $1,700.20 | $1,700.20 | $109.11 – $1,428.17 | 9 |
| Injection into hemorrhoid(s) CPT 46500 | not published | not published | $177.04 – $602.63 | 9 |
| Injection into spinal artery CPT 62294 | not published | not published | $861.66 – $1,979.86 | 8 |
| Injection into vocal cord CPT 31513 | not published | not published | $124.82 – $266.38 | 8 |
| Injection intraop add-on CPT 48400 | not published | not published | $97.58 – $214.19 | 8 |
| Injection, isavuconazonium HCPCS J1833 | not published | not published | $1.00 – $2.00 | 8 |
| Injection jaw joint x-ray CPT 21116 | not published | not published | $42.09 – $408.60 | 9 |
| Injection jugular CPT 36299 | $1,132.80 | $1,132.80 | $161.87 – $206.85 | 6 |
| Injection, khapzory, 0.5 mg HCPCS J0642 | not published | not published | $1.24 – $3.35 | 7 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $5.73 – $11.02 | 8 |
| Injection of HIV prep drug HCPCS G0012 | not published | not published | $13.89 – $29.14 | 8 |
| Injection of sinus tract CPT 20500 | $1,212.10 | $1,212.10 | $85.91 – $239.64 | 9 |
| Injection,onabotulinumtoxina HCPCS J0585 | $4,332.74 | $4,332.74 | $6.13 – $2,556.52 | 9 |
| Injection, pentamidine iseth HCPCS S0080 | $1,698.85 | $1,698.85 | $99.65 – $486.36 | 9 |
| Injection, peramivir HCPCS J2547 | not published | not published | $1.62 – $3.22 | 8 |
| Injection, piperacillin sodi HCPCS S0081 | not published | not published | $1.78 – $3.43 | 3 |
| Injection px peyronie ds CPT 54200 | not published | not published | $82.80 – $226.78 | 9 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $766.70 | $766.70 | $30.04 – $158.69 | 9 |
| Injection, renflexis HCPCS Q5104 | not published | not published | $25.05 – $51.92 | 8 |
| Injection, ruconest HCPCS J0596 | not published | not published | $32.24 – $64.16 | 8 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | not published | not published | $316.74 – $2,345.45 | 2 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $984.20 | $984.20 | $60.18 – $152.11 | 9 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,248.00 | $1,248.00 | $39.49 – $145.20 | 9 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $2,071.80 | $2,071.80 | $106.43 – $475.43 | 9 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $853.65 | $853.65 | $56.32 – $187.60 | 9 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $2,392.60 | $2,392.60 | $100.78 – $371.99 | 9 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $340.55 | $340.55 | $48.22 – $175.39 | 9 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $2,392.60 | $2,392.60 | $86.93 – $342.44 | 9 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $1,209.85 | $1,209.85 | $102.25 – $433.59 | 9 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,218.20 | $1,218.20 | $94.57 – $498.55 | 9 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $142.01 – $290.65 | 8 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $525.05 | $525.05 | $36.86 – $111.78 | 9 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $774.90 | $774.90 | $34.62 – $101.51 | 9 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $806.10 | $806.10 | $39.38 – $116.93 | 9 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $211.00 | $211.00 | $15.71 – $80.51 | 9 |
| Injection, ticarcillin disod HCPCS S0040 | not published | not published | $13.60 – $26.23 | 3 |
| Injection torsemide 10 mg/ml HCPCS J3265 | not published | not published | $2.19 – $5.85 | 3 |
| Injection treatment of eye CPT 66020 | not published | not published | $125.07 – $379.05 | 9 |
| Injection treatment of eye CPT 66030 | not published | not published | $106.00 – $341.79 | 9 |
| Injection treatment of nerve CPT 64605 | $352.35 | $352.35 | $259.19 – $456.27 | 9 |
| Injection treatment of nerve CPT 64610 | $352.35 | $352.35 | $259.19 – $516.49 | 9 |
| Injection treatment of nerve CPT 64681 | not published | not published | $211.73 – $870.54 | 9 |
| Injection treatment of nose CPT 30200 | not published | not published | $57.27 – $213.95 | 9 |
| Inject sacroiliac joint CPT 27096 | $1,818.90 | $1,818.90 | $79.53 – $316.74 | 9 |
| Inject/treat eye socket CPT 67500 | not published | not published | $61.57 – $148.41 | 9 |
| Inject/treat eye socket CPT 67505 | not published | not published | $68.35 – $164.47 | 9 |
| Inject/treat eye socket CPT 67515 | not published | not published | $44.63 – $98.29 | 9 |
| Inj, eculizumab-aagh, 2 mg HCPCS Q5151 | not published | not published | $31.35 – $32.29 | 5 |
| Inj, eculizumab-aeeb, 2 mg HCPCS Q5152 | not published | not published | $41.49 – $42.73 | 5 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | $20,278.63 | $20,278.63 | $31.92 – $19,061.91 | 9 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $21.12 – $43.75 | 8 |
| Inj., emapalumab-lzsg, 1 mg HCPCS J9210 | not published | not published | $366.67 – $700.90 | 8 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | not published | not published | $50.65 – $97.66 | 8 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $1,535.40 | $1,535.40 | $93.32 – $316.10 | 9 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $1,594.70 | $1,594.70 | $74.15 – $260.85 | 9 |
| Inj, epinephrine (belcher) HCPCS J0173 | not published | not published | $1.79 – $3.66 | 7 |
| Inj., eravacycline, 1 mg HCPCS J0122 | not published | not published | $1.08 – $2.38 | 7 |
| Inj, erzofri, 1 mg HCPCS J2428 | not published | not published | $17.15 – $17.66 | 5 |
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.