NOVANT HEALTH FORSYTH MEDICAL CENTER· WINSTON-SALEM, NC
HospitalCMS 4/5
3333 SILAS CREEK PARKWAY, WINSTON-SALEM, NC 27103
Procedures offered
942 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $182 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $158 | $274 | $488 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $94 | $151 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $101 | $148 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $68 | $161 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $109 | $180 | $308 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $88 | $162 | $298 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $127 | $201 | $345 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $139 | $231 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $123 | $225 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $84 | $137 | $239 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $142 | $238 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $150 | $261 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $146 | $267 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $76 | $158 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $85 | $174 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $48 | $99 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $63 | $157 | $285 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $175 | $444 | $881 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $318 | $467 | $882 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $98 | $213 | $413 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $169 | $255 | $413 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $178 | $323 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $183 | $323 | $606 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $185 | $409 | $680 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $265 | $373 | $628 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $187 | $500 | $868 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $170 | $524 | $924 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $1,422 | $3,204 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $107 | $138 |
| Spirometry CPT 94010 • Pulmonology | $18 | $32 | $67 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $15 | $49 | $94 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $77 | $147 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $44 | $60 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $71 | $141 | $188 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $7 | $19 | $40 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $15 | $30 | $67 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $47 | $67 | $132 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $40 | $54 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $13 | $61 | $142 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $0 | $3 | $6 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $24 | $30 | $38 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $72 | $83 | $99 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $101 | $131 | $209 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $165 | $230 | $369 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $38 | $287 | $515 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $375 | $583 | $1,032 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $239 | $540 | $916 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $34 | $73 | $124 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,530 | $2,217 | $3,672 |