NOVANT HEALTH FORSYTH MEDICAL CENTER· WINSTON-SALEM, NC

HospitalCMS 4/5

3333 SILAS CREEK PARKWAY, WINSTON-SALEM, NC 27103

Procedures offered

942 total

ProcedureMinAvgMax
Radiation treatment device design complex
CPT 77334 • Radiation Therapy
$89$170$274
Radiation physics consultation
CPT 77336 • Radiation Therapy
$83$97$106
Stereotactic radiosurgery (SRS) cranial
CPT 77371 • Radiation Therapy
$1,191$1,619$2,508
Stereotactic body radiation therapy (SBRT)
CPT 77373 • Radiation Therapy
$1,025$1,472$1,804
IMRT delivery simple
CPT 77385 • Radiation Therapy
$392$431$471
IMRT delivery complex
CPT 77386 • Radiation Therapy
$393$432$472
Radiation treatment delivery superficial
CPT 77407 • Radiation Therapy
$118$181$258
Radiation treatment delivery 3 or more MeV
CPT 77412 • Radiation Therapy
$139$256$361
Radiation treatment management 5 treatments
CPT 77427 • Radiation Therapy
$178$254$414
Radiation therapy management complete course
CPT 77431 • Radiation Therapy
$98$178$340
Proton beam treatment simple
CPT 77520 • Radiation Therapy
$100$903$1,956
Proton beam treatment complex
CPT 77523 • Radiation Therapy
$112$1,212$1,963
Polysomnography under age 6
CPT 95782 • Sleep Medicine
$893$1,160$1,443
Polysomnography under age 6 with CPAP
CPT 95783 • Sleep Medicine
$158$1,044$1,762
Sleep study unattended
CPT 95800 • Sleep Medicine
$63$167$387
Sleep study unattended minimum 3 channels
CPT 95801 • Sleep Medicine
$56$86$136
Multiple sleep latency test (MSLT)
CPT 95805 • Sleep Medicine
$52$475$1,012
Polysomnography age 6 or older
CPT 95810 • Sleep Medicine
$536$812$1,470
Polysomnography with CPAP titration
CPT 95811 • Sleep Medicine
$562$860$1,535
CPAP combination oral/nasal mask
HCPCS A7027 • Sleep Medicine
$88$133$197
Respiratory assist device BiPAP without backup
HCPCS E0470 • Sleep Medicine
$105$1,211$2,124
CPAP device continuous positive airway pressure
HCPCS E0601 • Sleep Medicine
$401$612$925
Laparoscopic partial nephrectomy
CPT 50543 • Urology
$221$1,954$3,617
Laparoscopic radical nephrectomy
CPT 50545 • Urology
$173$1,729$3,241
Lithotripsy extracorporeal shock wave (ESWL)
CPT 50590 • Urology
$438$947$1,808
Complex uroflowmetry
CPT 51741 • Urology
$8$31$81
Post-void residual urine measurement
CPT 51798 • Urology
$7$19$33
Cystourethroscopy diagnostic
CPT 52000 • Urology
$87$285$603
Cystourethroscopy with tumor fulguration small
CPT 52234 • Urology
$226$346$594
Cystourethroscopy with tumor fulguration medium
CPT 52235 • Urology
$297$432$695
Cystourethroscopy with dilation of ureteral stricture
CPT 52260 • Urology
$129$286$509
Cystourethroscopy with ureteral stent insertion
CPT 52332 • Urology
$164$505$992
Cystourethroscopy with lithotripsy
CPT 52353 • Urology
$424$585$946
TURP transurethral resection of prostate
CPT 52601 • Urology
$427$999$1,770
Laser vaporization of prostate
CPT 52648 • Urology
$740$2,024$3,985
Circumcision
CPT 54150 • Urology
$56$181$363
Orchiectomy simple
CPT 54520 • Urology
$222$431$797
Orchiectomy radical inguinal
CPT 54530 • Urology
$301$708$1,235
Vasectomy
CPT 55250 • Urology
$136$518$818
Prostate biopsy needle or punch
CPT 55700 • Urology
$148$276$450
Radical prostatectomy retropubic
CPT 55840 • Urology
$1,087$1,630$2,839
Laparoscopic radical prostatectomy
CPT 55866 • Urology
$698$2,174$4,778