FIRSTHEALTH MOORE REGIONAL HOSPITAL· PINEHURST, NC

ProviderCMS 4/5

155 MEMORIAL DR, PINEHURST, NC 28374

Procedures offered

949 total

Procedure	Min	Avg	Max
HPV vaccine 9-valent CPT 90651 • Preventive Care	$285	$328	$378
Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care	$232	$280	$364
Rotavirus vaccine pentavalent CPT 90680 • Preventive Care	$42	$95	$118
Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care	$20	$25	$37
MMR vaccine CPT 90707 • Preventive Care	$35	$90	$114
Tdap vaccine age 7 years or older CPT 90715 • Preventive Care	$44	$51	$56
Varicella vaccine CPT 90716 • Preventive Care	$50	$171	$230
Pneumococcal vaccine adult CPT 90732 • Preventive Care	$25	$128	$220
Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care	$195	$221	$248
Preventive visit new patient infant CPT 99381 • Preventive Care	$55	$137	$240
Preventive visit new patient age 1-4 CPT 99382 • Preventive Care	$55	$138	$251
Preventive visit new patient age 5-11 CPT 99383 • Preventive Care	$60	$138	$260
Preventive visit new patient age 12-17 CPT 99384 • Preventive Care	$70	$162	$292
Preventive visit new patient age 18-39 CPT 99385 • Preventive Care	$71	$148	$284
Preventive visit new patient age 40-64 CPT 99386 • Preventive Care	$86	$183	$327
Preventive visit new patient age 65+ CPT 99387 • Preventive Care	$78	$174	$355
Preventive visit established patient infant CPT 99391 • Preventive Care	$45	$103	$215
Preventive visit established patient age 1-4 CPT 99392 • Preventive Care	$50	$113	$228
Preventive visit established patient age 5-11 CPT 99393 • Preventive Care	$50	$121	$228
Preventive visit established patient age 12-17 CPT 99394 • Preventive Care	$63	$143	$249
Preventive visit established patient age 18-39 CPT 99395 • Preventive Care	$65	$141	$256
Preventive visit established patient age 40-64 CPT 99396 • Preventive Care	$70	$161	$272
Preventive visit established patient age 65+ CPT 99397 • Preventive Care	$75	$158	$293
Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care	$23	$56	$85
Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care	$111	$262	$412
Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care	$214	$447	$742
Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care	$213	$412	$742
Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care	$195	$257	$362
Annual wellness visit initial HCPCS G0438 • Preventive Care	$150	$227	$361
Annual wellness visit subsequent HCPCS G0439 • Preventive Care	$109	$191	$285
Bronchoscopy diagnostic CPT 31622 • Pulmonology	$137	$307	$551
Bronchoscopy with brushing CPT 31623 • Pulmonology	$78	$314	$601
Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology	$31	$271	$561
Bronchoscopy with biopsy CPT 31625 • Pulmonology	$160	$443	$759
Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology	$31	$367	$807
Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology	$226	$1,232	$2,096
Ventilation assist and management initiation CPT 94002 • Pulmonology	$75	$117	$195
Spirometry CPT 94010 • Pulmonology	$11	$37	$61
Spirometry before and after bronchodilator CPT 94060 • Pulmonology	$40	$58	$87
Bronchospasm provocation evaluation CPT 94070 • Pulmonology	$26	$53	$84
Respiratory flow volume loop CPT 94375 • Pulmonology	$19	$46	$86
Cardiopulmonary exercise test CPT 94621 • Pulmonology	$92	$204	$343
Nebulizer inhalation treatment CPT 94640 • Pulmonology	$9	$18	$30
Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology	$14	$26	$40
Plethysmography lung volumes CPT 94726 • Pulmonology	$13	$50	$99
Gas dilution lung volumes CPT 94727 • Pulmonology	$13	$39	$75
Diffusing capacity (DLCO) CPT 94729 • Pulmonology	$12	$48	$74
Pulse oximetry single measurement CPT 94760 • Pulmonology	$2	$4	$8
Pulse oximetry continuous overnight CPT 94762 • Pulmonology	$19	$34	$55
Radiation therapy planning simple CPT 77261 • Radiation Therapy	$68	$106	$154