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 |
|---|---|---|---|---|
| Ob Ultrasound nuchal meas add-on CPT 76814 | $123.70 | $123.70 | $26.40 – $103.91 | 9 |
| Occlude fallopian tube(s) device 58615 CPT 58615 | not published | not published | $240.42 – $516.48 | 8 |
| Occupational Therapy Evaluation (high complexity) CPT 97167 | $675.65 | $675.65 | $98.55 – $288.68 | 9 |
| Occupational Therapy Evaluation (low complexity) CPT 97165 | $675.65 | $675.65 | $98.55 – $285.10 | 9 |
| Occupational Therapy Evaluation (moderate complexity) CPT 97166 | $675.65 | $675.65 | $98.55 – $288.68 | 9 |
| Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 | $24,979.54 | $24,979.54 | $59.70 – $23,480.77 | 9 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $50.59 | $50.59 | $0.89 – $23.55 | 9 |
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | $24,805.75 | $24,805.75 | $208.63 – $23,317.41 | 9 |
| Ocular function screen CPT 99172 | not published | not published | $6.77 – $33.41 | 4 |
| Ocular instrumnt screen bil CPT 99174 | not published | not published | $5.54 – $12.87 | 6 |
| Ocular instrumnt screen bil CPT 99177 | not published | not published | $4.29 – $10.16 | 6 |
| Ocular photodynamic ther CPT 67221 | not published | not published | $197.52 – $519.11 | 9 |
| Ocular reconst transplant CPT 65780 | not published | not published | $567.72 – $1,193.60 | 8 |
| Ocular reconst transplant CPT 65781 | not published | not published | $1,264.39 – $2,665.79 | 8 |
| Ocular reconst transplant CPT 65782 | not published | not published | $1,092.61 – $2,303.17 | 8 |
| Ofatumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9302 | not published | not published | $61.54 – $420.23 | 8 |
| Off base opioid tx, 60 m HCPCS G2087 | not published | not published | $155.50 – $824.92 | 8 |
| Off base opioid tx 70min HCPCS G2086 | not published | not published | $155.50 – $893.03 | 8 |
| Office consultation CPT 99241 | not published | not published | $64.75 – $64.75 | 1 |
| Office emergency care CPT 99058 | not published | not published | $27.19 – $42.70 | 4 |
| Off/op cnsltj new/est low 30 CPT 99243 | $414.00 | $414.00 | $86.90 – $128.47 | 9 |
| Off/op cnsltj new/est mod 40 CPT 99244 | $591.20 | $591.20 | $124.73 – $168.78 | 9 |
| Off/op consltj new/est hi 55 CPT 99245 | $718.85 | $718.85 | $124.73 – $204.97 | 9 |
| Off/op consltj new/est sf 20 CPT 99242 | $328.65 | $328.65 | $54.86 – $128.47 | 9 |
| Offset knee joint each HCPCS L2390 | not published | not published | $129.88 – $326.97 | 7 |
| Offset knee joint heavy duty HCPCS L2395 | not published | not published | $185.65 – $467.35 | 7 |
| Oil silicone ophth 8.5ml silikon 1000 HCPCS C1814 | $495.00 | $495.00 | $364.12 – $465.30 | 6 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | $360.76 | $360.76 | $0.95 – $139.78 | 9 |
| Olanzapine long-acting inj HCPCS J2358 | not published | not published | $2.83 – $5.60 | 8 |
| Ol dig e/m svc 11-20 min CPT 99422 | not published | not published | $24.22 – $56.54 | 9 |
| Ol dig e/m svc 21+ min CPT 99423 | not published | not published | $37.86 – $89.95 | 9 |
| Ol dig e/m svc 5-10 min CPT 99421 | not published | not published | $12.11 – $28.91 | 9 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | $10,163.50 | $10,163.50 | $38.33 – $4,776.85 | 9 |
| Omental flap extra-abdom 49904 CPT 49904 | not published | not published | $1,298.44 – $2,826.43 | 8 |
| Omental flap intra-abdom 49905 CPT 49905 | not published | not published | $323.92 – $709.66 | 8 |
| Onc breast mrna 12 genes CPT 81522 | not published | not published | $1,549.20 – $7,886.20 | 7 |
| Onc breast mrna 58 genes CPT 81520 | not published | not published | $2,510.21 – $5,259.73 | 7 |
| Onc breast mrna 70 genes CPT 81521 | not published | not published | $3,873.00 – $8,115.31 | 7 |
| Onc brst mrna 11 genes CPT 81518 | not published | not published | $1,549.20 – $8,115.31 | 7 |
| Onc brst mrna 70 cnt 31 gene CPT 81523 | not published | not published | $1,549.20 – $7,886.20 | 7 |
| Onc cutan mlnma mrna 31 gene CPT 81529 | not published | not published | $2,877.20 – $14,646.39 | 7 |
| Oncology colon mrna CPT 81525 | not published | not published | $1,206.66 – $6,344.80 | 7 |
| Oncology colorectal scr CPT 81528 | not published | not published | $203.55 – $1,036.16 | 7 |
| Oncology gynecologic CPT 81535 | not published | not published | $231.78 – $1,179.90 | 7 |
| Oncology gynecologic CPT 81536 | not published | not published | $71.02 – $361.55 | 7 |
| Oncology lung CPT 81538 | not published | not published | $279.35 – $5,845.93 | 7 |
| Oncology prostate prob score CPT 81539 | not published | not published | $304.00 – $1,547.51 | 7 |
| Oncology thyroid CPT 81545 | not published | not published | $1,440.00 – $1,440.00 | 1 |
| Oncology tissue of origin CPT 81504 | not published | not published | $208.00 – $1,058.82 | 7 |
| Oncology tum unknown origin CPT 81540 | not published | not published | $1,206.66 – $7,635.75 | 7 |
| Onco (ovar) five proteins CPT 81503 | not published | not published | $358.80 – $1,826.47 | 7 |
| Onco (ovar) two proteins CPT 81500 | not published | not published | $104.20 – $530.43 | 7 |
| Oncoprotein dcp CPT 83951 | not published | not published | $31.81 – $131.15 | 7 |
| Oncoprotein her-2/neu CPT 83950 | not published | not published | $31.81 – $131.15 | 7 |
| Onc prostate 3 genes CPT 81551 | not published | not published | $1,077.50 – $4,133.49 | 7 |
| Onc prostate mrna 22 cnt gen CPT 81542 | not published | not published | $573.20 – $8,115.31 | 7 |
| Onc prostate mrna 46 genes CPT 81541 | not published | not published | $3,873.00 – $8,115.31 | 7 |
| Onc thyr mrna 10,196 gen alg CPT 81546 | not published | not published | $1,440.00 – $7,330.32 | 7 |
| Onc uveal mlnma mrna 15 gene CPT 81552 | not published | not published | $309.84 – $15,833.49 | 7 |
| Ondansetron 4 mg s0119 HCPCS S0119 | not published | not published | $0.46 – $29.82 | 4 |
| Ondansetron 8 mg disintegrating tablet HCPCS Q0162 | $2.87 | $2.87 | $0.01 – $2.68 | 9 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $64.01 | $64.01 | $0.09 – $3.48 | 9 |
| One-way allow prorated trip HCPCS P9604 | not published | not published | $4.18 – $21.01 | 6 |
| One way chest drain valve HCPCS A7040 | not published | not published | $43.88 – $109.65 | 7 |
| Oocyte identification CPT 89254 | not published | not published | $165.85 – $170.82 | 5 |
| Oophorectomy partial or total 58943 CPT 58943 | not published | not published | $1,132.07 – $2,455.68 | 8 |
| Open ablate liver tumor cryo CPT 47381 | not published | not published | $1,380.34 – $3,011.46 | 8 |
| Open ablate liver tumor rf CPT 47380 | not published | not published | $1,349.33 – $2,940.29 | 8 |
| Open aortic tube prosth repair 34830 CPT 34830 | not published | not published | $1,578.87 – $3,497.46 | 8 |
| Open aortofemor prosth repr CPT 34832 | not published | not published | $1,697.08 – $3,759.76 | 8 |
| Open aortoiliac prosth repr 34831 CPT 34831 | not published | not published | $1,734.40 – $3,824.82 | 8 |
| Open bx/exc inguinofem nodes CPT 38531 | not published | not published | $423.82 – $916.39 | 8 |
| Open bx of lung pleura 32098 CPT 32098 | not published | not published | $697.71 – $1,523.02 | 8 |
| Open cor endarterect w cabg/ea ves 33572 CPT 33572 | not published | not published | $206.60 – $456.16 | 8 |
| Open nasoethmoid fx with fixj CPT 21339 | not published | not published | $733.09 – $1,548.77 | 8 |
| Open nasoethmoid fx without fixj CPT 21338 | not published | not published | $647.49 – $1,371.87 | 8 |
| Open periprosthetic breast capsule 19370 CPT 19370 | not published | not published | $644.83 – $1,372.54 | 8 |
| Open skull for drainage 61312 CPT 61312 | not published | not published | $1,915.48 – $4,269.46 | 8 |
| Open tenotomy tendon flexor foot single or multiple 28230 CPT 28230 | $644.70 | $644.70 | $276.52 – $833.28 | 9 |
| Open thrombectomy of av fistula without revision 36831 CPT 36831 | not published | not published | $560.39 – $1,229.54 | 8 |
| Open tx compl front sinus fx CPT 21344 | not published | not published | $1,328.38 – $2,835.92 | 8 |
| Open tx iliac spine uni/bil HCPCS G0412 | not published | not published | $694.52 – $1,486.41 | 8 |
| Open tx nose fx w/skele fixj CPT 21330 | not published | not published | $516.20 – $1,093.29 | 8 |
| Open tx nose & septal fx CPT 21335 | not published | not published | $688.23 – $1,464.73 | 8 |
| Open tx post pelvic fxcture HCPCS G0415 | not published | not published | $1,303.92 – $2,791.18 | 8 |
| Open tx rib 1-3 fx w/fix 21811 CPT 21811 | not published | not published | $545.85 – $1,197.00 | 8 |
| Open tx rib 4-6 fx w/fix 21812 CPT 21812 | not published | not published | $661.57 – $1,444.40 | 8 |
| Open tx rib 7+ fx w/fix 21813 CPT 21813 | not published | not published | $902.55 – $1,979.19 | 8 |
| Open tx/sternum fracture 21825 CPT 21825 | not published | not published | $525.06 – $1,130.58 | 8 |
| Open wedge/bx lung infiltr CPT 32096 | not published | not published | $740.58 – $1,607.74 | 8 |
| Open wedge bx lung nodule 32097 CPT 32097 | not published | not published | $740.33 – $1,610.45 | 8 |
| Ophthalmic biometry CPT 92136 | not published | not published | $16.91 – $57.18 | 8 |
| Ophthalmic endoscope add-on CPT 66990 | not published | not published | $83.68 – $176.23 | 8 |
| Ophthalmic mitomycin HCPCS J7315 | $1,810.30 | $1,810.30 | $438.60 – $1,320.47 | 9 |
| Ophthalmodynamometry CPT 92260 | not published | not published | $10.26 – $37.27 | 9 |
| Ophth Ultrasound b & quant a CPT 76510 | not published | not published | $28.69 – $73.88 | 8 |
| Oph Ultrasound dx ant sgm Ultrasound uni/bi CPT 76513 | not published | not published | $31.08 – $64.38 | 8 |
| Oph Ultrasound dx quan a-scan only CPT 76511 | not published | not published | $20.84 – $67.45 | 8 |
| Opioids & opiate analogs 3/4 CPT 80363 | not published | not published | $21.23 – $21.23 | 1 |
| Opn abltj 1/> rnl mas crysrg CPT 50250 | not published | not published | $1,151.84 – $2,452.28 | 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.