NOVANT HEALTH FORSYTH MEDICAL CENTER· WINSTON-SALEM, NC

HospitalCMS 4/5

3333 SILAS CREEK PARKWAY, WINSTON-SALEM, NC 27103

Procedures offered

959 total

ProcedureMinAvgMax
Respiratory flow volume loop
CPT 94375 • Pulmonology
$15$38$60
Cardiopulmonary exercise test
CPT 94621 • Pulmonology
$71$133$188
Nebulizer inhalation treatment
CPT 94640 • Pulmonology
$7$20$40
Aerosol or vapor inhalation initial demonstration
CPT 94664 • Pulmonology
$15$29$67
Plethysmography lung volumes
CPT 94726 • Pulmonology
$47$66$132
Gas dilution lung volumes
CPT 94727 • Pulmonology
$15$36$54
Diffusing capacity (DLCO)
CPT 94729 • Pulmonology
$11$55$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$82$99
Radiation therapy planning intermediate
CPT 77262 • Radiation Therapy
$101$129$209
Radiation therapy planning complex
CPT 77263 • Radiation Therapy
$165$224$369
Radiation therapy simulation simple
CPT 77280 • Radiation Therapy
$38$270$515
Radiation therapy simulation complex
CPT 77290 • Radiation Therapy
$108$512$1,032
3-dimensional radiation therapy plan
CPT 77295 • Radiation Therapy
$239$518$916
Radiation therapy dose calculation
CPT 77300 • Radiation Therapy
$34$66$124
IMRT radiation therapy plan
CPT 77301 • Radiation Therapy
$443$1,892$3,672
Radiation treatment device design complex
CPT 77334 • Radiation Therapy
$89$164$274
Radiation physics consultation
CPT 77336 • Radiation Therapy
$83$97$106
Stereotactic radiosurgery (SRS) cranial
CPT 77371 • Radiation Therapy
$1,191$1,562$2,508
Stereotactic body radiation therapy (SBRT)
CPT 77373 • Radiation Therapy
$1,025$1,520$1,804
IMRT delivery simple
CPT 77385 • Radiation Therapy
$392$444$471
IMRT delivery complex
CPT 77386 • Radiation Therapy
$393$445$472
Radiation treatment delivery superficial
CPT 77407 • Radiation Therapy
$118$179$258
Radiation treatment delivery 3 or more MeV
CPT 77412 • Radiation Therapy
$139$244$361
Radiation treatment management 5 treatments
CPT 77427 • Radiation Therapy
$178$253$414
Radiation therapy management complete course
CPT 77431 • Radiation Therapy
$98$167$340
Proton beam treatment simple
CPT 77520 • Radiation Therapy
$100$769$1,956
Proton beam treatment complex
CPT 77523 • Radiation Therapy
$112$1,029$1,963
Polysomnography under age 6
CPT 95782 • Sleep Medicine
$152$1,049$1,443
Polysomnography under age 6 with CPAP
CPT 95783 • Sleep Medicine
$158$1,077$1,762
Sleep study unattended
CPT 95800 • Sleep Medicine
$63$167$387
Sleep study unattended minimum 3 channels
CPT 95801 • Sleep Medicine
$52$81$136
Multiple sleep latency test (MSLT)
CPT 95805 • Sleep Medicine
$52$497$1,012
Polysomnography age 6 or older
CPT 95810 • Sleep Medicine
$158$746$1,470
Polysomnography with CPAP titration
CPT 95811 • Sleep Medicine
$562$842$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$1,224$2,124
CPAP device continuous positive airway pressure
HCPCS E0601 • Sleep Medicine
$401$573$925
Laparoscopic partial nephrectomy
CPT 50543 • Urology
$221$2,131$3,841
Laparoscopic radical nephrectomy
CPT 50545 • Urology
$173$1,872$3,241
Lithotripsy extracorporeal shock wave (ESWL)
CPT 50590 • Urology
$438$969$1,808
Complex uroflowmetry
CPT 51741 • Urology
$8$37$92
Post-void residual urine measurement
CPT 51798 • Urology
$7$20$33
Cystourethroscopy diagnostic
CPT 52000 • Urology
$87$305$612
Cystourethroscopy with tumor fulguration small
CPT 52234 • Urology
$226$366$594
Cystourethroscopy with tumor fulguration medium
CPT 52235 • Urology
$297$450$695
Cystourethroscopy with dilation of ureteral stricture
CPT 52260 • Urology
$129$300$509
Cystourethroscopy with ureteral stent insertion
CPT 52332 • Urology
$164$562$1,025
Cystourethroscopy with lithotripsy
CPT 52353 • Urology
$424$614$946