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 |
|---|---|---|---|---|
| Post-coital mucous exam HCPCS Q0115 | not published | not published | $10.00 – $50.90 | 7 |
| Post d/c phone follow up HCPCS G0544 | not published | not published | $47.37 – $100.31 | 6 |
| Post non-seg/spine instrumentation 22840 CPT 22840 | not published | not published | $692.96 – $1,531.83 | 8 |
| Postop applicat rigid dsg on HCPCS L6388 | not published | not published | $555.73 – $1,398.97 | 7 |
| Postop app non-wgt bear dsg HCPCS L5450 | $1,101.65 | $1,101.65 | $386.25 – $1,035.55 | 9 |
| Postop app non-wgt bear dsg HCPCS L5460 | not published | not published | $567.90 – $1,429.62 | 7 |
| Postop dress & 1 cast chg bk HCPCS L5400 | not published | not published | $1,141.05 – $2,872.43 | 7 |
| Postop dsg & 1 cast chg ak/d HCPCS L5420 | not published | not published | $1,441.10 – $3,627.76 | 7 |
| Postop dsg ak ea add cast ch HCPCS L5430 | not published | not published | $499.16 – $1,256.56 | 7 |
| Postop dsg bk ea add cast ch HCPCS L5410 | not published | not published | $435.72 – $1,096.86 | 7 |
| Postop dsg cast chg elb dis/ HCPCS L6382 | not published | not published | $1,449.65 – $3,649.30 | 7 |
| Postop dsg cast chg wrst/elb HCPCS L6380 | not published | not published | $1,112.32 – $2,800.08 | 7 |
| Postop ea cast chg & realign HCPCS L6386 | not published | not published | $428.80 – $1,079.43 | 7 |
| Post-operative body jacket HCPCS L1310 | not published | not published | $1,701.85 – $4,284.16 | 7 |
| Post-op hip abduct custom fa HCPCS L1685 | not published | not published | $1,411.37 – $3,552.90 | 7 |
| Post op service lvrs min 6 HCPCS G0305 | not published | not published | $513.54 – $528.94 | 5 |
| Postpartum Care Only CPT 59430 | $362.80 | $362.80 | $164.30 – $513.33 | 9 |
| Post seg spine instrument/3-6 seg 22842 CPT 22842 | not published | not published | $699.57 – $1,546.07 | 8 |
| Potassium 24 hour urine CPT 84133 | $87.50 | $87.50 | $2.13 – $50.43 | 9 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $197.20 | $197.20 | $0.11 – $14.29 | 9 |
| Potassium hydroxide preps HCPCS Q0112 | not published | not published | $2.33 – $11.87 | 7 |
| Potassium serum/plasma/whole blood CPT 84132 | $104.65 | $104.65 | $2.27 – $56.49 | 9 |
| Pouch clsd w barr attached HCPCS A5051 | not published | not published | $2.30 – $5.72 | 7 |
| Pouch drainable w barrier at HCPCS A5061 | not published | not published | $3.92 – $9.81 | 7 |
| Pouch high output 2pc 50mm red HCPCS A4413 | not published | not published | $6.13 – $15.31 | 7 |
| Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp HCPCS A4388 | not published | not published | $4.85 – $12.12 | 7 |
| Pouch ostmy nb pouchkin ctf HCPCS A5062 | not published | not published | $2.48 – $6.21 | 7 |
| Pouch uros new (both sides) 2.75in clr HCPCS A4432 | not published | not published | $3.99 – $9.96 | 7 |
| Powder prem protct 1oz HCPCS A4371 | not published | not published | $4.05 – $10.14 | 7 |
| Ppp2r2b gen detc abnor allel CPT 81343 | not published | not published | $54.80 – $278.96 | 7 |
| Pq biliary strict dil s&i CPT 74363 | $1,755.10 | $1,755.10 | $37.59 – $1,393.90 | 9 |
| Pq dr cath chg w cont s&i CPT 75984 | $933.90 | $933.90 | $35.76 – $701.65 | 9 |
| Pq kyphplsty 1 bdy lumb w/img CPT 22514 | $32,469.60 | $32,469.60 | $446.44 – $3,328.71 | 9 |
| Pq thr inj ext pse CPT 36002 | $1,267.00 | $1,267.00 | $96.40 – $294.89 | 9 |
| Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl CPT 22512 | $6,682.20 | $6,682.20 | $191.92 – $1,391.58 | 9 |
| Pq vrtbrplst 1 bdy inj crv-thr w/img ini CPT 22510 | $13,363.70 | $13,363.70 | $406.85 – $3,326.36 | 9 |
| Pq vrtbrplst 1 bdy inj lmb-scr w/img ini CPT 22511 | $13,363.70 | $13,363.70 | $383.56 – $3,326.36 | 9 |
| Pralatrexate injection HCPCS J9307 | $53,180.10 | $53,180.10 | $289.14 – $24,994.65 | 9 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | $882.56 | $882.56 | $88.43 – $431.60 | 9 |
| Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr CPT 26951 | $5,324.65 | $5,324.65 | $333.64 – $922.42 | 9 |
| Pr application of long arm splint CPT 29105 | $369.70 | $369.70 | $38.77 – $99.71 | 9 |
| Pr application splint static short arm CPT 29125 | $319.45 | $319.45 | $38.62 – $99.71 | 9 |
| Pr assessment emotional/behavioral per instrument brief CPT 96127 | $15.60 | $15.60 | $3.93 – $9.49 | 9 |
| Pr biopsy skin punch single lesion CPT 11104 | $600.90 | $600.90 | $44.35 – $241.57 | 9 |
| Pr correction hallux valgus (bunionectomy) with sesamoidectomy when performed with first metatarsal and cuneiform joint arthrodesis any method CPT 28297 | not published | not published | $580.71 – $1,970.43 | 9 |
| Pr correction hammertoe CPT 28285 | $857.55 | $857.55 | $372.47 – $1,042.73 | 9 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | $63.75 | $63.75 | $11.13 – $26.62 | 9 |
| Prcrd drg 0-5yr or w/anomly CPT 33018 | $2,687.55 | $2,687.55 | $262.08 – $2,257.54 | 9 |
| Prcrd drg 6+yr without anomly CPT 33017 | $2,687.55 | $2,687.55 | $223.79 – $2,257.54 | 9 |
| Pr cystourethroscopy with insertion indwelling ureteral stent CPT 52332 | $5,529.65 | $5,529.65 | $146.76 – $770.32 | 9 |
| Pr discharge day management hospital ip/obs <=30 min on ecounter date CPT 99238 | $445.05 | $445.05 | $77.25 – $106.64 | 9 |
| Pr discharge day management hospital ip/obs > 30 min on encounter date CPT 99239 | $566.75 | $566.75 | $100.96 – $129.02 | 9 |
| Prealbumin CPT 84134 | $184.45 | $184.45 | $7.20 – $94.56 | 9 |
| Pr ecg 12 lead report only CPT 93010 | not published | not published | $7.68 – $16.26 | 8 |
| Pr ecg external < 48 hours continuous recording/storage r&i by a phys/qhp CPT 93227 | $110.50 | $110.50 | $17.41 – $43.18 | 9 |
| Prednisolone acetate inj HCPCS J2650 | not published | not published | $0.52 – $0.95 | 3 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $41.24 | $41.24 | $0.24 – $6.39 | 9 |
| Prednisone 1 mg tablet HCPCS J7512 | $38.74 | $38.74 | $0.01 – $0.78 | 9 |
| Prefab glove for term device HCPCS L6890 | not published | not published | $178.32 – $448.90 | 7 |
| Pregabalin - sendout CPT 80366 | not published | not published | $3.31 – $50.16 | 4 |
| Pr egd flexible transoral w/placement percutaneous gastrostomy tube CPT 43246 | not published | not published | $186.73 – $401.25 | 8 |
| Pregnancy associated plasma protein-a CPT 84163 | $91.80 | $91.80 | $7.44 – $65.24 | 9 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $1,119.90 | $1,119.90 | $34.71 – $76.47 | 9 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $1,108.15 | $1,108.15 | $44.98 – $196.39 | 9 |
| Pregnancy Ultrasound (limited) CPT 76815 | $747.15 | $747.15 | $29.52 – $65.44 | 9 |
| Pr e&m preventive medicine initial comprehensive new patient 12-17 years CPT 99384 | $242.60 | $242.60 | $94.97 – $203.39 | 8 |
| Prenatal Care Only (4-6 visits) CPT 59425 | not published | not published | $398.77 – $1,092.19 | 9 |
| Prenatal Care Only (7+ visits) CPT 59426 | not published | not published | $731.42 – $1,998.07 | 9 |
| Pre-op service lvrs 10-15dos HCPCS G0303 | not published | not published | $301.39 – $310.43 | 5 |
| Pre-op service lvrs 1-9 dos HCPCS G0304 | not published | not published | $513.54 – $528.94 | 5 |
| Pre-op service lvrs complete HCPCS G0302 | not published | not published | $513.54 – $528.94 | 5 |
| Prep ak ischial direct form HCPCS L5570 | not published | not published | $2,248.15 – $5,659.37 | 7 |
| Prep ak ischial laminated HCPCS L5590 | not published | not published | $2,629.24 – $6,618.73 | 7 |
| Prep ak ischial plast molded HCPCS L5560 | not published | not published | $1,864.11 – $4,692.61 | 7 |
| Prep ak ischial thermo mold HCPCS L5580 | not published | not published | $2,331.58 – $5,869.41 | 7 |
| Preparation for bladder xray CPT 51605 | not published | not published | $36.59 – $77.95 | 8 |
| Preparation palate mold CPT 42280 | not published | not published | $104.91 – $340.51 | 9 |
| Prepare donor heart CPT 33944 | not published | not published | $273.01 – $637.97 | 8 |
| Prepare donor heart/lung CPT 33933 | not published | not published | $387.40 – $817.22 | 8 |
| Prepare donor intestine CPT 44715 | not published | not published | $387.17 – $788.36 | 8 |
| Prepare donor lung double CPT 32856 | not published | not published | $337.96 – $705.42 | 8 |
| Prepare donor lung single CPT 32855 | not published | not published | $280.10 – $573.08 | 8 |
| Prepare embryo for transfer CPT 89255 | not published | not published | $51.71 – $53.26 | 5 |
| Prepare fecal microbiota CPT 44705 | not published | not published | $70.11 – $216.52 | 7 |
| Prepare heart-aorta conduit CPT 33404 | not published | not published | $1,593.71 – $3,479.15 | 8 |
| Prepare penis study CPT 54230 | not published | not published | $76.42 – $206.23 | 9 |
| Prepare sperm duct x-ray CPT 55300 | not published | not published | $175.69 – $373.46 | 8 |
| Prep bk ptb laminated socket HCPCS L5540 | not published | not published | $1,957.26 – $4,927.09 | 7 |
| Prep bk ptb open end socket HCPCS L5535 | not published | not published | $2,058.46 – $5,181.86 | 7 |
| Prep bk ptb plaster molded HCPCS L5510 | not published | not published | $1,728.92 – $4,352.32 | 7 |
| Prep bk ptb thermopls molded HCPCS L5530 | not published | not published | $1,973.23 – $4,967.29 | 7 |
| Prep cadaver renal allograft CPT 50323 | not published | not published | $200.30 – $422.75 | 8 |
| Prep corneal endo allograft CPT 65757 | not published | not published | $157.05 – $319.79 | 8 |
| Prep donor intestine/artery CPT 44721 | not published | not published | $350.50 – $769.30 | 8 |
| Prep donor intestine/venous CPT 44720 | not published | not published | $250.11 – $549.69 | 8 |
| Prep donor liver 3-segment CPT 47144 | not published | not published | $491.65 – $1,001.10 | 8 |
| Prep donor liver/arterial CPT 47147 | not published | not published | $349.96 – $768.62 | 8 |
| Prep donor liver lobe split CPT 47145 | not published | not published | $491.65 – $1,001.10 | 8 |
| Prep donor liver/venous CPT 47146 | not published | not published | $299.56 – $658.14 | 8 |
| Prep donor liver whole CPT 47143 | not published | not published | $327.78 – $700.92 | 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.