LAKE NORMAN REGIONAL MEDICAL CENTER· MOORESVILLE, NC
HospitalCMS 2/5
171 FAIRVIEW ROAD, MOORESVILLE, NC 28117
Procedures offered
935 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $116 | $167 | $234 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $134 | $209 | $328 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $113 | $137 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $78 | $127 | $150 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $78 | $142 | $210 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $88 | $138 | $230 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $89 | $144 | $174 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $100 | $144 | $191 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $112 | $173 | $208 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $24 | $48 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $643 | $2,195 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $295 | $835 | $2,195 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $197 | $697 | $2,195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $89 | $217 | $400 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $277 | $509 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $211 | $401 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $186 | $1,726 | $5,919 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $190 | $1,746 | $5,919 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $190 | $1,718 | $5,919 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $195 | $1,802 | $5,919 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $245 | $1,895 | $5,919 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $274 | $3,353 | $7,926 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $97 | $134 | $184 |
| Spirometry CPT 94010 • Pulmonology | $11 | $31 | $56 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $19 | $47 | $76 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $42 | $57 | $75 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $29 | $36 | $49 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $108 | $150 | $206 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $20 | $29 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $21 | $26 | $37 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $17 | $42 | $66 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $51 | $92 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $12 | $60 | $98 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $0 | $2 | $4 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $11 | $31 | $52 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $69 | $99 | $144 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $105 | $188 | $331 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $164 | $231 | $342 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $43 | $284 | $552 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $366 | $574 | $917 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $457 | $787 | $1,445 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $62 | $65 | $69 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $498 | $2,639 | $5,672 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $75 | $194 | $386 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $77 | $159 | $274 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,058 | $1,429 | $2,147 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $964 | $1,852 | $3,058 |
| IMRT delivery simple CPT 77385 • Radiation Therapy | $392 | $392 | $392 |
| IMRT delivery complex CPT 77386 • Radiation Therapy | $393 | $616 | $839 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $88 | $215 | $384 |