Supplies, drugs & other prices at Alice Peck Day Memorial Hospital

Lebanon, NH · every code in this section with a posted price and a Medicare benchmark.

26 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Admin hepatitis b vaccine (G0010) $35.03 $65 0.7×
Admin influenza virus vac (G0008) $35.03 $65 0.7×
Admin pneumococcal vaccine (G0009) $35.03 $65 0.7×
Alcohol/sub misuse assess (G2011) $16.98 $31.50 0.5×
Annual alcohol screen 15 min (G0442) $16.44 $30.50 0.4×
Brief alcohol misuse counsel (G0443) $26.41 $49 0.2×
Ca screen;pelvic/breast exam (G0101) $49.58 $92 0.5×
Depression screen annual (G0444) $18.60 $34.50 0.5×
Diab manage trn per indiv (G0108) $45.28 $84 0.8×
Direct refer hospital observ (G0379) $58.21 $108 0.1×
Ekg tracing for initial prev (G0404) $24.25 $45 0.8×
Extracorporeal shock wave involving musculoskeletal system, not otherwise specified (0101T) $105.10 $195 0.4×
Home sleep test/type 3 porta (G0399) $174.64 $324 0.8×
Home sleep test/type 4 porta (G0400) $92.44 $171.50 0.4×
Initial preventive exam (G0402) $184.07 $341.50 1.3×
Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion,… (0707T) $210.21 $390 0.1×
Neuro csf prion prtn qual (0035U) $184.88 $343 0.3×
Njx pltlt plasma w/img harvest/preparation (0232T) $844.16 $1,050 1.8×
Obtaining screen pap smear (Q0091) $23.44 $43.50 0.8×
Ppps, initial visit (G0438) $315.32 $585 1.8×
Ppps, subseq visit (G0439) $158.20 $293.50 1.1×
Syphilis tst non-treponemal antibody ia qual rpr (0065U) $50.67 $94 2.8×
Tomosynthesis, mammo (G0279) $122.35 $227 9.6×
Tpmt nudt15 gene analysis common variants (0034U) $369.75 $686 0.8×
Trim nail(s) (G0127) $32.88 $61 0.5×
Visit to determ ldct elig (G0296) $26.95 $50 0.2×