NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY· MOUNT AIRY, NC
ProviderCMS 4/5
830 ROCKFORD ST, MOUNT AIRY, NC 27030
Procedures offered
941 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $228 | $246 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $78 | $99 | $114 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $128 | $188 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $123 | $195 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $100 | $146 | $219 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $136 | $213 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $160 | $245 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $123 | $174 | $266 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $82 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $78 | $96 | $106 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $73 | $89 | $106 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $126 | $187 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $121 | $192 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $131 | $204 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $144 | $220 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $32 | $64 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $131 | $190 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $293 | $371 | $556 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $182 | $346 | $557 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $162 | $271 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $210 | $271 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $162 | $214 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $186 | $334 | $413 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $190 | $308 | $451 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $190 | $309 | $421 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $195 | $349 | $570 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $245 | $397 | $605 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $274 | $1,098 | $1,911 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $112 | $146 |
| Spirometry CPT 94010 • Pulmonology | $11 | $31 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $19 | $48 | $68 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $36 | $62 | $98 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $23 | $43 | $65 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $89 | $121 | $195 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $16 | $29 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $22 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $44 | $71 | $95 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $48 | $75 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $55 | $94 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $0 | $3 | $6 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $11 | $28 | $41 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $84 | $95 | $106 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $108 | $138 | $178 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $188 | $230 | $276 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $43 | $148 | $270 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $82 | $441 | $738 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $224 | $821 | $1,445 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $37 | $71 | $94 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $498 | $1,394 | $2,538 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $75 | $138 | $190 |