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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 1St psychiatric collab care mgmt 1st 70 mins (99492) range across 2 matching MRF lines |
$116.42–$174.10 | $216–$323 | varies |
| Actigraphy Testing Recording Analysis I&R (95803) range across 2 matching MRF lines |
$80.85–$230.15 | $150–$427 | varies |
| Actinotherapy Ultraviolet Light (96900) | $18.33 | $34 | 0.5× |
| Acupunct W/Stimul 15 Min (97813) range across 2 matching MRF lines |
$25.87–$33.42 | $48–$62 | varies |
| Acupuncture 1/> ndles w/o elec stimj init 15 min (97810) range across 2 matching MRF lines |
$25.87–$33.42 | $48–$62 | varies |
| Admn Sarscov2 Vacc 1 Dose (90480) range across 2 matching MRF lines |
$80–$84 | $80–$84 | varies |
| Advncd Care Plan 30 Min (99497) range across 2 matching MRF lines |
$63.60–$90.55 | $118–$168 | varies |
| Airway Inhalation Treatment (94640) range across 2 matching MRF lines |
$31.80–$94.32 | $59–$175 | varies |
| Appl modality 1+ areas lllt po pain reduction (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) range across 2 matching MRF lines |
$215.06–$321.24 | $399–$596 | varies |
| Behavral qualit analys voice (92524) | $210.21 | $390 | 1.9× |
| Brief Emotional/Behav Assmt (96127) | $23.72 | $44 | 0.6× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 2 matching MRF lines |
$23.18–$345.50 | $43–$641 | varies |
| C motor evoked upr&lwr limbs (95939) | $1,560.94 | $2,896 | 1.7× |
| Canalith repositioning proc (95992) range across 2 matching MRF lines |
$42.04–$77.08 | $78–$143 | varies |
| Cardiac Stress Tst,Tracing Only (93017) | $832.22 | $1,544 | 3.6× |
| Cardiopulmonary resuscitation (92950) range across 3 matching MRF lines |
$146.07–$591.82 | $271–$1,098 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$86.78–$315.85 | $161–$586 | varies |
| Care mgmt services behavioral hlth cond 20 mins (99484) range across 2 matching MRF lines |
$35.03–$53.90 | $65–$100 | varies |
| 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× |
| Chemo IV infusion addl hr (96415) | $121.27 | $225 | 1.6× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $404.25 | $750 | 1.1× |
| Chest Wall Manipulation (94668) | $84.08 | $156 | 0.6× |
| Chiropractic manipulative treatment (CMT); spinal, 1-2 regions Facility (98940) range across 2 matching MRF lines |
$20.48–$31.80 | $38–$59 | varies |
| Color/duplex Doppler, complete (93975) | $756.76 | $1,404 | 3.0× |
| Color/duplex Doppler, limited (93976) range across 3 matching MRF lines |
$354.12–$547.62 | $657–$1,016 | varies |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $83.54 | $155 | 2.6× |
| Complex chronic care mgmt svc 1st 60 min cal mo (99487) range across 2 matching MRF lines |
$40.42–$134.75 | $75–$250 | varies |
| Cont gluc mntr physician/qhp provided equiptment (95250) | $127.20 | $236 | 0.9× |
| Cont Gluc Mntr Pt Prov Eqp (95249) | $44.20 | $82 | 0.7× |
| Continuous Pulse Ox (94762) | $197.27 | $366 | 1.4× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 3 matching MRF lines |
$59.83–$507.20 | $111–$941 | varies |
| Cpt initial (94667) | $128.28 | $238 | 0.9× |
| Critical care first hour (99291) range across 2 matching MRF lines |
$290.52–$1,415.95 | $539–$2,627 | varies |
| Debridement Open Wound 20 Sq Cm< (97597) range across 3 matching MRF lines |
$80.85–$193.50 | $150–$359 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $939.48 | $1,743 | 3.7× |
| Dup-scan xtr veins unilateral/limited study (93971) range across 2 matching MRF lines |
$28.57–$568.64 | $53–$1,055 | varies |
| Echo Heart Xthoracic,Limited (93308) range across 5 matching MRF lines |
$31.26–$1,546.39 | $58–$2,869 | varies |
| EEG extended monitoring 61-119 minutes (95813) | $719.03 | $1,334 | 3.1× |
| Electrical Stimulation Ea 15 Min (97032) | $60.37 | $112 | 4.1× |
| Electrocardiogram Tracing (93005) | $162.78 | $302 | 2.6× |
| Emergency Dept Visit Level 2 (99282) range across 2 matching MRF lines |
$180.03–$251.17 | $334–$466 | varies |
| Emergency Dept Visit Level 3 (99283) range across 2 matching MRF lines |
$239.32–$376.76 | $444–$699 | varies |
| Emergency Dept Visit Level 4 (99284) range across 2 matching MRF lines |
$375.14–$503.43 | $696–$934 | varies |
| Emg 3 Extremities (95863) | $305.61 | $567 | 2.2× |
| Er level 1 (99281) range across 2 matching MRF lines |
$143.91–$146.61 | $267–$272 | varies |
| Er level v (99285) range across 2 matching MRF lines |
$511.51–$755.14 | $949–$1,401 | varies |
| Evaluate pt use of inhaler (94664) range across 3 matching MRF lines |
$24.79–$108.88 | $46–$202 | varies |
| Evaluate Speech Production (92522) | $210.21 | $390 | 1.9× |
| Evaluate Swallowing Function (92610) | $68.99 | $128 | 0.8× |
| Evaluation of speech fluency (92521) | $210.21 | $390 | 1.6× |
| Excimer laser tx psoriasis 250-500 sq cm (96921) range across 2 matching MRF lines |
$155.23–$232.31 | $288–$431 | varies |
| Excimer laser tx psoriasis >500 sq cm (96922) range across 2 matching MRF lines |
$209.67–$314.78 | $389–$584 | varies |
| Excimer laser tx psoriasis tot area <250 sq cm (96920) range across 2 matching MRF lines |
$141.22–$211.83 | $262–$393 | varies |
| External ECG rec>48hr<7d recording (93242) range across 2 matching MRF lines |
$29.11–$187.57 | $54–$348 | varies |
| External ECG rec>7d<15d recording (93246) range across 2 matching MRF lines |
$29.11–$251.17 | $54–$466 | varies |
| External Ecg Scanning Analysis Report (93226) | $447.37 | $830 | 7.1× |
| Extracranial Bilat Study (93880) | $672.67 | $1,248 | 2.6× |
| Extracranial Uni/Ltd Study (93882) | $607.45 | $1,127 | 5.4× |
| Group Therapeutic Procedures (97150) | $24.79 | $46 | 1.4× |
| Health Behavior Assessment/Re-Assessment (96156) range across 2 matching MRF lines |
$78.15–$117.50 | $145–$218 | varies |
| Holter monitor recording (93225) | $359.51 | $667 | 2.5× |
| Im Adm Intransl/Oral 1 Vaccine (90473) | $35.03 | $65 | 0.5× |
| Immunization administration (90471) | $35.03 | $65 | 0.5× |
| Inital newborn e/m (99460) | $81.39 | $151 | 0.6× |
| Iontophoresis 15 min (97033) | $60.37 | $112 | 3.2× |
| Irrig Drug Delivery Device (96523) range across 3 matching MRF lines |
$35.57–$118.58 | $66–$220 | varies |
| IV infusion hydration each additional hour (96361) range across 2 matching MRF lines |
$90.01–$100.79 | $167–$187 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 2 matching MRF lines |
$222.07–$277.05 | $412–$514 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 2 matching MRF lines |
$139.60–$143.91 | $259–$267 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 2 matching MRF lines |
$30.18–$111.03 | $56–$206 | varies |
| IV push initial (96374) range across 2 matching MRF lines |
$32.34–$129.90 | $60–$241 | varies |
| Motion Fluoroscopy/Swallow (92611) | $236.62 | $439 | 2.6× |
| Multiple Sleep Latency Test (95805) range across 2 matching MRF lines |
$105.10–$1,087.70 | $195–$2,018 | varies |
| Muscle Test 2 Limbs (95861) range across 2 matching MRF lines |
$240.93–$285.13 | $447–$529 | varies |
| Muscle Test Hemidiaphragm (95866) range across 2 matching MRF lines |
$82.47–$124.51 | $153–$231 | varies |
| Muscle Test Nonparaspinal (95870) | $80.85 | $150 | 0.6× |
| Muscle Test One Limb (95860) | $168.71 | $313 | 1.2× |
| Nasopharyngoscopy (92511) | $44.20 | $82 | 0.2× |
| Needle Electromyography Cranial Nrv Muscle Bi (95868) range across 2 matching MRF lines |
$185.95–$465.16 | $345–$863 | varies |
| Needle Electromyography Cranial Nrv Muscle Uni (95867) | $140.14 | $260 | 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) range across 2 matching MRF lines |
$275.97–$414.49 | $512–$769 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) range across 2 matching MRF lines |
$35.57–$39.89 | $66–$74 | varies |
| Nerve Conduction Studies 1-2 Studies (95907) | $133.13 | $247 | 0.6× |
| Nerve Conduction Studies 11-12 Studies (95912) | $359.51 | $667 | 0.9× |
| Nerve conduction studies 13 or more 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× |
| Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) | $62.52 | $116 | 0.5× |
| Neuromuscular Reeducation (97112) | $50.13 | $93 | 1.5× |
| Newborn resuscitation (99465) | $204.28 | $379 | 0.3× |
| Oral Function Therapy (92526) | $205.90 | $382 | 2.4× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $40.96 | $76 | 0.8× |
| 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 eval high complexity (97167) | $246.32 | $457 | 2.4× |
| Ot Eval Low Complex (97165) | $137.44 | $255 | 1.4× |
| Ot Eval Moderate Complexity (97166) | $187.03 | $347 | 1.9× |
| Ot manual therapy 15 min (97140) range across 2 matching MRF lines |
$33.42–$62.52 | $62–$116 | varies |
| Ot paraffin bath (97018) | $17.25 | $32 | 2.9× |
| Ot Prosthetic Training, Each 15 Min (97761) | $75.46 | $140 | 1.9× |
| Ot Re-Eval Est Plan Care (97168) | $121.81 | $226 | 1.8× |
| 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) range across 2 matching MRF lines |
$116.42–$174.10 | $216–$323 | varies |
| Photochemotx Psoralens&Ultraviolet Puva (96912) | $85.16 | $158 | 1.4× |
| Photochemotx Tar&Uvb/Petrolatum/Uvb (96910) | $99.71 | $185 | 1.6× |
| Physical Performance Test (97750) range across 2 matching MRF lines |
$67.37–$83.54 | $125–$155 | varies |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) range across 2 matching MRF lines |
$228.54–$1,968.97 | $424–$3,653 | varies |
| Polysom <6 yrs 4/> paramtrs (95782) range across 2 matching MRF lines |
$177.87–$2,506.35 | $330–$4,650 | varies |
| Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) range across 2 matching MRF lines |
$172.48–$2,506.35 | $320–$4,650 | varies |
| Polysom Any Age Sleep Stage 1-3 Addl Param Attnd (95808) range across 2 matching MRF lines |
$397.24–$595.06 | $737–$1,104 | varies |
| Psych diag eval w/med srvcs (90792) range across 2 matching MRF lines |
$150.38–$226.38 | $279–$420 | varies |
| Psychiatric diagnostic evaluation (90791) range across 2 matching MRF lines |
$141.76–$211.83 | $263–$393 | varies |
| Psytx Crisis Initial 60 Min (90839) range across 2 matching MRF lines |
$107.26–$161.70 | $199–$300 | varies |
| Pt Eval High Complex (97163) | $246.32 | $457 | 2.5× |
| Pt eval low complex 20 min (97161) | $137.44 | $255 | 1.4× |
| Pt Eval Mod Complex (97162) | $200.51 | $372 | 2.0× |
| Pt gait training 15 min (97116) | $45.28 | $84 | 1.6× |
| Pt mechanical traction (97012) | $73.30 | $136 | 5.1× |
| Pt Re-Eval Est Plan Care (97164) | $129.90 | $241 | 1.9× |
| Pt-focused hlth risk assmt score doc stnd instrm (96160) | $6.47 | $12 | 0.2× |
| Pulm function test by gas (94727) | $285.13 | $529 | 1.2× |
| Pulmonary Stress Testing (94618) range across 2 matching MRF lines |
$39.89–$222.07 | $74–$412 | varies |
| Pure Tone Audiometry Air (92552) range across 2 matching MRF lines |
$29.64–$31.26 | $55–$58 | varies |
| Remote 30 Day Ecg Rev/Report (93270) | $274.35 | $509 | 6.9× |
| Same day nb discharge (99463) | $111.57 | $207 | 0.8× |
| Sbsq Psyc Collab Care Mgmt (99493) range across 2 matching MRF lines |
$116.42–$174.10 | $216–$323 | varies |
| Self Care Mngment Training (97535) | $35.03 | $65 | 1.1× |
| Self-meas bp pt educaj/traing & dev calibration (99473) | $15.09 | $28 | 0.5× |
| Sensory Integration Ea 15 Min (97533) | $70.61 | $131 | 1.2× |
| Sleep study unattended (95806) range across 2 matching MRF lines |
$109.42–$261.95 | $203–$486 | varies |
| Slp caregiver training 1st 30 min (97550) | $33.96 | $63 | 0.6× |
| Somatosensory Testing (95938) | $1,576.04 | $2,924 | 1.7× |
| Speech sound lang comprehen (92523) | $263.03 | $488 | 1.2× |
| Spirometry (94010) range across 3 matching MRF lines |
$14.55–$261.95 | $27–$486 | varies |
| 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 Ea Addl 15 Min (97130) | $39.89 | $74 | 1.9× |
| Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) | $33.42 | $62 | 0.9× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $67.37 | $125 | 2.3× |
| Ther/Proph/Diag Inj Ia (96373) range across 3 matching MRF lines |
$14.01–$35.03 | $26–$65 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 2 matching MRF lines |
$41.50–$85.70 | $77–$159 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 2 matching MRF lines |
$279.20–$300.22 | $518–$557 | varies |
| Therapeutic Activities (97530) | $43.66 | $81 | 1.2× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) range across 2 matching MRF lines |
$28.03–$70.07 | $52–$130 | varies |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) range across 3 matching MRF lines |
$15.09–$24.25 | $28–$45 | varies |
| Trans Care Mgmt 14 Day Disch (99495) range across 2 matching MRF lines |
$156.31–$235 | $290–$436 | varies |
| Trans Care Mgmt 7 Day Disch (99496) range across 2 matching MRF lines |
$211.83–$318.01 | $393–$590 | varies |
| Tte w/doppler, complete (93306) range across 4 matching MRF lines |
$1,455.30–$1,536.15 | $2,700–$2,850 | varies |
| 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/Pro/Dx Inj New Drug Addon (96375) range across 2 matching MRF lines |
$17.79–$93.25 | $33–$173 | varies |
| Tympanometry (92567) | $16.71 | $31 | 0.4× |
| 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) range across 2 matching MRF lines |
$29.64–$94.32 | $55–$175 | varies |
| Wheelchair Mgmt Ea 15 Min (97542) | $68.99 | $128 | 2.2× |
| Whirlpool Therapy (97022) | $45.81 | $85 | 2.9× |
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.