Visits & medical services prices at Alice Peck Day Memorial Hospital

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

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

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ProcedureCash priceGross charge× Medicare
1St psyc collab care mgmt (99492) $145.26 $269.50 1.3×
Actigraphy testing recording analysis i&r (95803) $155.50 $288.50 2.5×
Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) $29.64 $55 1.0×
Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the… (97813) $29.64 $55 1.0×
Advance care planning first 30 mins (99497) $77.08 $143 0.7×
Airway inhalation treatment (94640) $63.06 $117 0.3×
Appl modality 1+lllt po pain (97037) $21.56 $40 0.5×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $47.97 $89 3.3×
Assessment of aphasia per hr (96105) $79.77 $148 0.8×
Assmt & care planning pt w/cognitive impairment (99483) $268.15 $497.50 2.5×
Bedside Swallowing Eval (92610) $68.99 $128 0.8×
Behavioral and qualitative analysis of voice and resonance (92524) $210.21 $390 1.9×
Brief Emotional/Behavioral Assessment (96127) $23.72 $44 0.6×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $184.34 $342 0.5×
C motor evoked upr&lwr limbs (95939) $1,560.94 $2,896 1.7×
Canalith Repositioning Procedure (95992) $59.56 $110.50 1.5×
Cardiac Stress Tst,Tracing Only (93017) $832.22 $1,544 3.6×
Cardiopulmonary resuscitation (92950) $308.85 $573 1.3×
Cardioversion (92960) $201.32 $373.50 0.3×
Care mgmt svc bhvl hlth cond (99484) $44.46 $82.50 1.1×
Caregiver hlth risk assmt score doc stnd instrm (96161) $45.81 $85 1.1×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $49.59 $92 1.9×
Cbt 1st hour (94644) $95.40 $177 0.7×
Chemother, IV infusion, 1 hr (96413) $404.25 $750 1.1×
Chemother, IV infusion, ea add hr (96415) $121.27 $225 1.6×
Chiropractic manipulative treatment (CMT); spinal, 1-2 regions Facility (98940) $26.14 $48.50 1.1×
Color/duplex Doppler, complete (93975) $756.76 $1,404 3.0×
Color/duplex Doppler, limited (93976) $450.87 $1,016 4.0×
Complex chronic care mgmt svc 1st 60 min cal mo (99487) $87.58 $162.50 0.5×
Cont Gluc Monitoring Patient Provided Equipment (95249) $44.20 $82 0.7×
Continuous Glucose Monitoring (95250) $127.20 $236 0.9×
Cpap/bipap (94660) $59.83 $111 0.3×
Cpt initial (94667) $128.28 $238 0.9×
Critical care (99291) $853.24 $1,583 1.0×
Debridement Open Wound 20 Sq Cm< (97597) $133.13 $247 0.6×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $939.48 $1,743 3.7×
Dup-scan xtr veins unilateral/limited study (93971) $298.60 $554 2.7×
Duplex scan extracranial art compl bi study (93880) $672.67 $1,248 2.6×
Echo Heart Xthoracic,Limited (93308) $282.97 $525 1.1×
EEG greater than 1 hour (95813) $719.03 $1,334 3.1×
Electrocardiogram Tracing (93005) $162.78 $302 2.6×
EMG one extremity (95860) $168.71 $313 1.2×
EMG three extremities (95863) $305.61 $567 2.2×
EMG two extremities (95861) $263.03 $488 1.9×
Er level 1 (99281) $145.26 $269.50 1.6×
Er level ii (99282) $215.60 $400 1.3×
Er level iii (99283) $308.04 $571.50 1.1×
Er level IV (99284) $439.28 $815 1.0×
Er level v (99285) $633.32 $1,175 1.0×
Eval speech sound production (92522) $210.21 $390 1.9×
Evaluate Pt Use Of Inhaler (94664) $108.88 $202 0.5×
Evaluation of speech fluency (92521) $210.21 $390 1.6×
Excimer laser tx psoriasis 250-500 sq cm (96921) $193.77 $359.50 0.9×
Excimer laser tx psoriasis >500 sq cm (96922) $262.22 $486.50 0.6×
Excimer laser tx psoriasis tot area <250 sq cm (96920) $176.52 $327.50 0.8×
External ECG rec>48hr<7d recording (93242) $108.34 $201 2.7×
External ECG rec>7d<15d recording (93246) $140.14 $260 3.5×
External Ecg Scanning Analysis Report (93226) $447.37 $830 7.1×
Group Therapeutic Procedures (97150) $24.79 $46 1.4×
Health Behavior Assessment/Re-Assessment (96156) $97.82 $181.50 0.9×
Holter Monitor (93225) $359.51 $667 2.5×
Imm admn sarscov2 vaccine single dose (90480) $82 $82 1.9×
Immune Admin Oral/Nasal (90473) $35.03 $65 0.5×
Immunization Admin (90471) $35.03 $65 0.5×
Inital newborn e/m (99460) $81.39 $151 0.6×
Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and… (99463) $111.57 $207 0.8×
Injection intra arterial (96373) $24.52 $26 0.1×
Iontophoresis 15 min (97033) $60.37 $112 3.2×
Irrig drug delivery device (96523) $118.58 $220 1.9×
IV infusion hydration each additional hour (96361) $95.40 $177 1.9×
IV infusion hydration initial 31 min-1 hour (96360) $249.56 $463 1.1×
IV infusion ther proph addl sequential to 1 hr (96367) $141.76 $263 1.8×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $289.71 $537.50 1.3×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $70.60 $131 1.4×
IV push ea addl new drug (96375) $55.52 $103 1.1×
IV push initial (96374) $81.12 $150.50 0.4×
Manual therapy 15 min (97140) $47.97 $89 1.7×
Massage 15 min (97124) $67.37 $125 2.3×
Mechanical traction (97012) $73.30 $136 5.1×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $236.62 $439 2.6×
Multiple Sleep Latency Test (95805) $596.40 $1,106.50 0.7×
Nasopharyngoscopy (92511) $44.20 $82 0.2×
Needle Electromyography Cranial Nrv Muscle Bi (95868) $325.56 $604 1.4×
Needle Electromyography Cranial Nrv Muscle Uni (95867) $140.14 $260 0.6×
Needle electromyography hemidiaphragm (95866) $103.49 $192 0.8×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $80.85 $150 0.6×
Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) $129.90 $241 0.6×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $345.23 $640.50 0.8×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $37.73 $70 0.2×
Nerve Conduction Studies 11-12 Studies (95912) $359.51 $667 0.9×
Nerve conduction studies 13/> studies (95913) $415.03 $770 1.0×
Nerve Conduction Studies 3-4 Studies (95908) $173.02 $321 0.8×
Nerve Conduction Studies 5-6 Studies (95909) $206.44 $383 0.9×
Nerve Conduction Studies 7-8 Studies (95910) $272.73 $506 0.7×
Nerve Conduction Studies 9-10 Studies (95911) $325.56 $604 0.8×
Nerve conduction studies; 1-2 studies (95907) $133.13 $247 0.6×
Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) $62.52 $116 0.5×
Newborn resuscitation (99465) $204.28 $379 0.3×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $197.27 $366 1.4×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $74.38 $138 1.6×
Osteopathic Manipulative Tx 1-2 Body Regions (98925) $40.42 $75 1.8×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $83.54 $155 2.6×
Ot eval high complex 60 min (97167) $246.32 $457 2.4×
Ot eval low complex 30 min (97165) $137.44 $255 1.4×
Ot eval mod complex 45 min (97166) $187.03 $347 1.9×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $40.96 $76 0.8×
Ot Prosthetic Training, Each 15 Min (97761) $75.46 $140 1.9×
Ot re-evaluation (97168) $121.81 $226 1.8×
Ot therapeutic activity 15 min (97530) $43.66 $81 1.2×
Paraffin bath pt (97018) $17.25 $32 2.9×
Patch/Application Test Specify Number Tests (95044) $3.77 $7 0.0×
Pdt dstr prmlg les skn illum/activj per day (96567) $107.26 $199 0.5×
Phlebotomy therapeutic (99195) $145.26 $269.50 1.0×
Photochemotherapy; psoralens and ultraviolet A (PUVA) Facility (96912) $85.16 $158 1.4×
Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B Facility (96910) $99.71 $185 1.6×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) $1,098.76 $2,038.50 1.2×
Polysom <6 yrs 4/> paramtrs (95782) $1,342.11 $2,490 1.5×
Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) $1,339.42 $2,485 1.5×
Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) $496.15 $920.50 0.5×
Psych diag eval w/med srvcs (90792) $188.38 $349.50 1.0×
Psychiatric diagnostic evaluation (90791) $176.80 $328 0.9×
Psytx crisis initial 60 min (90839) $134.48 $249.50 0.7×
Pt Aquatic Therapy/Exercises (97113) $33.42 $62 0.9×
Pt Electrical Stimulation (97032) $60.37 $112 4.1×
Pt eval high complex 45 min (97163) $246.32 $457 2.5×
Pt eval low complex 20 min (97161) $137.44 $255 1.4×
Pt eval mod complex 30 min (97162) $200.51 $372 2.0×
Pt gait training 15 min (97116) $45.28 $84 1.6×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $50.13 $93 1.5×
Pt Physical Performance Test (97750) $75.46 $140 2.2×
Pt re-evaluation (97164) $129.90 $241 1.9×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $35.03 $65 1.1×
Pt Whirlpool Therapy (97022) $45.81 $85 2.9×
Pt-focused hlth risk assmt (96160) $6.47 $12 0.2×
Pulm function test by gas (94727) $285.13 $529 1.2×
Pulmonary stress test simple (94618) $130.98 $243 0.9×
Pure Tone Audiometry Air Only (92552) $30.45 $56.50 0.2×
Remote 30 Day Ecg Rev/Report - Cardiac Event Monitor (93270) $274.35 $509 6.9×
Rt Chest Wall Manipulation,Subsequent (94668) $84.08 $156 0.6×
Sbsq psyc collab care mgmt (99493) $145.26 $269.50 1.3×
Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device… (99473) $15.09 $28 0.5×
Sensory Integration Ea 15 Min (97533) $70.61 $131 1.2×
Sleep study unattended (95806) $185.68 $344.50 0.8×
Slp caregiver training 1st 30 min (97550) $33.96 $63 0.6×
Smoking cessation > 10 min (99407) $49.05 $91 1.2×
Somatosensory testing (95938) $1,576.04 $2,924 1.7×
Speech sound lang comprehen (92523) $263.03 $488 1.2×
Spirometry (94010) $22.10 $41 0.1×
Standardized Cognitive Performance Testing (96125) $230.15 $427 2.2×
Temp transcutaneous pacing (92953) $114.81 $213 0.2×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $39.89 $74 1.8×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $39.89 $74 1.9×
Therapeutic prophylactic/dx injection subq/im (96372) $63.60 $118 0.8×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $15.09 $28 0.4×
Trans Care Mgmt 14 Day Disch (99495) $195.66 $363 1.4×
Trans Care Mgmt 7 Day Disch (99496) $264.92 $491.50 1.9×
Tte w/doppler, complete (93306) $1,495.72 $2,775 2.6×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $283.51 $526 3.7×
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $20.48 $38 0.9×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $205.90 $382 2.4×
Tympanometry (92567) $16.71 $31 0.4×
Ultraviolet Light Therapy (96900) $18.33 $34 0.5×
Vasc Duplex Scan Extracranial,Limited (93882) $607.45 $1,127 5.4×
Vent mgmt inpat init day (94002) $750.83 $1,393 1.1×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $577.27 $1,071 0.9×
Vital capacity, total (94150) $61.98 $115 0.5×
Wheelchair Mgmt Ea 15 Min (97542) $68.99 $128 2.2×