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
Radiation therapy planning intermediate CPT 77262 • Radiation Therapy	$106	$166	$282
Radiation therapy planning complex CPT 77263 • Radiation Therapy	$192	$233	$279
Radiation therapy simulation simple CPT 77280 • Radiation Therapy	$228	$325	$462
Radiation therapy simulation complex CPT 77290 • Radiation Therapy	$436	$642	$866
3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy	$267	$793	$1,791
Radiation therapy dose calculation CPT 77300 • Radiation Therapy	$47	$79	$111
IMRT radiation therapy plan CPT 77301 • Radiation Therapy	$405	$2,106	$3,272
Radiation treatment device design complex CPT 77334 • Radiation Therapy	$80	$127	$214
Radiation physics consultation CPT 77336 • Radiation Therapy	$68	$123	$287
Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy	$1,007	$1,334	$1,633
Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy	$993	$1,802	$2,927
IMRT delivery simple CPT 77385 • Radiation Therapy	$364	$445	$525
IMRT delivery complex CPT 77386 • Radiation Therapy	$471	$499	$527
Radiation treatment delivery superficial CPT 77407 • Radiation Therapy	$135	$233	$280
Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy	$150	$258	$363
Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy	$188	$281	$424
Radiation therapy management complete course CPT 77431 • Radiation Therapy	$107	$133	$162
Proton beam treatment simple CPT 77520 • Radiation Therapy	$129	$804	$1,296
Proton beam treatment complex CPT 77523 • Radiation Therapy	$228	$952	$1,501
Polysomnography under age 6 CPT 95782 • Sleep Medicine	$122	$901	$1,274
Polysomnography under age 6 with CPAP CPT 95783 • Sleep Medicine	$133	$956	$1,359
Sleep study unattended CPT 95800 • Sleep Medicine	$0	$100	$179
Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine	$0	$59	$126
Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine	$144	$417	$600
Polysomnography age 6 or older CPT 95810 • Sleep Medicine	$116	$694	$1,095
Polysomnography with CPAP titration CPT 95811 • Sleep Medicine	$586	$839	$1,131
CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine	$129	$156	$198
Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine	$115	$544	$1,549
CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine	$133	$533	$782
Laparoscopic partial nephrectomy CPT 50543 • Urology	$1,507	$2,069	$2,287
Laparoscopic radical nephrectomy CPT 50545 • Urology	$1,346	$1,898	$2,156
Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology	$558	$1,015	$1,380
Complex uroflowmetry CPT 51741 • Urology	$8	$81	$247
Post-void residual urine measurement CPT 51798 • Urology	$14	$31	$78
Cystourethroscopy diagnostic CPT 52000 • Urology	$77	$310	$602
Cystourethroscopy with tumor fulguration small CPT 52234 • Urology	$274	$401	$686
Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology	$321	$418	$488
Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology	$201	$276	$323
Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology	$175	$568	$963
Cystourethroscopy with lithotripsy CPT 52353 • Urology	$435	$669	$1,175
TURP transurethral resection of prostate CPT 52601 • Urology	$824	$1,129	$1,350
Laser vaporization of prostate CPT 52648 • Urology	$673	$2,202	$3,147
Circumcision CPT 54150 • Urology	$112	$282	$718
Orchiectomy simple CPT 54520 • Urology	$323	$470	$590
Orchiectomy radical inguinal CPT 54530 • Urology	$576	$688	$772
Vasectomy CPT 55250 • Urology	$228	$551	$1,070
Prostate biopsy needle or punch CPT 55700 • Urology	$145	$282	$350
Radical prostatectomy retropubic CPT 55840 • Urology	$365	$1,526	$2,056
Laparoscopic radical prostatectomy CPT 55866 • Urology	$312	$1,924	$2,677