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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × 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) range across 2 matching MRF lines |
$14.01–$19.94 | $26–$37 | varies |
| Annual alcohol screen 15 min (G0442) range across 2 matching MRF lines |
$13.47–$19.40 | $25–$36 | varies |
| Brief alcohol misuse counsel (G0443) range across 2 matching MRF lines |
$21.02–$31.80 | $39–$59 | varies |
| Ca screen;pelvic/breast exam (G0101) range across 2 matching MRF lines |
$40.42–$58.75 | $75–$109 | varies |
| Depression screen annual (G0444) range across 2 matching MRF lines |
$15.09–$22.10 | $28–$41 | varies |
| 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 muscskel sys nos (0101T) | $105.10 | $195 | 0.4× |
| Home sleep test/type 3 porta (G0399) range across 2 matching MRF lines |
$87.32–$261.95 | $162–$486 | varies |
| Home sleep test/type 4 porta (G0400) range across 2 matching MRF lines |
$73.84–$111.03 | $137–$206 | varies |
| Initial preventive exam (G0402) range across 2 matching MRF lines |
$146.07–$222.07 | $271–$412 | varies |
| Neuro csf prion prtn qual (0035U) | $184.88 | $343 | 0.3× |
| Njx bone sub matrl into subchondral bone defect (0707T) | $210.21 | $390 | 0.1× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$481.33–$1,207 | $893–$1,207 | varies |
| Obtaining screen pap smear (Q0091) range across 2 matching MRF lines |
$18.86–$28.03 | $35–$52 | varies |
| Ppps, initial visit (G0438) range across 2 matching MRF lines |
$309.39–$321.24 | $574–$596 | varies |
| Ppps, subseq visit (G0439) range across 2 matching MRF lines |
$99.71–$216.68 | $185–$402 | varies |
| Syphilis tst non-treponemal antibody ia qual rpr (0065U) | $50.67 | $94 | 2.8× |
| Tomosynthesis, mammo (G0279) | $122.35 | $227 | 9.6× |
| Tpmt and Nudt15 Genotype (0034U) | $369.75 | $686 | 0.8× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$25.33–$40.42 | $47–$75 | varies |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$21.02–$32.88 | $39–$61 | varies |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.