SENTARA ALBEMARLE REGIONAL MEDICAL CENTER· ELIZABETH CITY, NC

HospitalCMS 3/5

3050 HALSTEAD BLVD, ELIZABETH CITY, NC 27909

Procedures offered

949 total

Procedure	Min	Avg	Max
HPV vaccine 9-valent CPT 90651 • Preventive Care	$314	$341	$378
Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care	$232	$262	$283
Rotavirus vaccine pentavalent CPT 90680 • Preventive Care	$101	$110	$118
Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care	$20	$23	$27
MMR vaccine CPT 90707 • Preventive Care	$97	$105	$114
Tdap vaccine age 7 years or older CPT 90715 • Preventive Care	$39	$46	$56
Varicella vaccine CPT 90716 • Preventive Care	$187	$208	$230
Pneumococcal vaccine adult CPT 90732 • Preventive Care	$119	$131	$149
Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care	$219	$227	$248
Preventive visit new patient infant CPT 99381 • Preventive Care	$57	$120	$155
Preventive visit new patient age 1-4 CPT 99382 • Preventive Care	$70	$130	$170
Preventive visit new patient age 5-11 CPT 99383 • Preventive Care	$73	$138	$167
Preventive visit new patient age 12-17 CPT 99384 • Preventive Care	$86	$134	$187
Preventive visit new patient age 18-39 CPT 99385 • Preventive Care	$83	$145	$181
Preventive visit new patient age 40-64 CPT 99386 • Preventive Care	$100	$171	$215
Preventive visit new patient age 65+ CPT 99387 • Preventive Care	$111	$177	$228
Preventive visit established patient infant CPT 99391 • Preventive Care	$61	$111	$161
Preventive visit established patient age 1-4 CPT 99392 • Preventive Care	$55	$107	$147
Preventive visit established patient age 5-11 CPT 99393 • Preventive Care	$64	$103	$147
Preventive visit established patient age 12-17 CPT 99394 • Preventive Care	$63	$117	$160
Preventive visit established patient age 18-39 CPT 99395 • Preventive Care	$65	$127	$164
Preventive visit established patient age 40-64 CPT 99396 • Preventive Care	$82	$144	$174
Preventive visit established patient age 65+ CPT 99397 • Preventive Care	$75	$148	$187
Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care	$27	$55	$97
Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care	$150	$207	$267
Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care	$243	$371	$580
Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care	$244	$393	$573
Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care	$150	$176	$232
Annual wellness visit initial HCPCS G0438 • Preventive Care	$150	$181	$231
Annual wellness visit subsequent HCPCS G0439 • Preventive Care	$121	$148	$183
Bronchoscopy diagnostic CPT 31622 • Pulmonology	$137	$346	$438
Bronchoscopy with brushing CPT 31623 • Pulmonology	$159	$377	$475
Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology	$138	$269	$444
Bronchoscopy with biopsy CPT 31625 • Pulmonology	$187	$411	$502
Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology	$210	$509	$683
Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology	$265	$1,306	$1,911
Ventilation assist and management initiation CPT 94002 • Pulmonology	$92	$112	$130
Spirometry CPT 94010 • Pulmonology	$8	$23	$40
Spirometry before and after bronchodilator CPT 94060 • Pulmonology	$26	$46	$93
Bronchospasm provocation evaluation CPT 94070 • Pulmonology	$47	$97	$183
Respiratory flow volume loop CPT 94375 • Pulmonology	$26	$41	$55
Cardiopulmonary exercise test CPT 94621 • Pulmonology	$74	$120	$183
Nebulizer inhalation treatment CPT 94640 • Pulmonology	$7	$16	$31
Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology	$19	$24	$32
Plethysmography lung volumes CPT 94726 • Pulmonology	$12	$51	$77
Gas dilution lung volumes CPT 94727 • Pulmonology	$12	$37	$61
Diffusing capacity (DLCO) CPT 94729 • Pulmonology	$9	$54	$76
Pulse oximetry single measurement CPT 94760 • Pulmonology	$3	$5	$9
Pulse oximetry continuous overnight CPT 94762 • Pulmonology	$27	$33	$38
Radiation therapy planning simple CPT 77261 • Radiation Therapy	$68	$109	$186