ASHE MEMORIAL HOSPITAL· JEFFERSON, NC
HospitalCMS 3/5
200 HOSPITAL AVE, JEFFERSON, NC 28640
Procedures offered
935 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $187 | $318 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $126 | $206 | $346 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $104 | $154 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $68 | $105 | $164 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $127 | $222 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $85 | $114 | $138 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $88 | $142 | $250 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $162 | $266 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $138 | $171 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $37 | $85 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $85 | $121 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $184 | $323 | $476 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $219 | $293 | $372 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $90 | $167 | $252 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $161 | $212 | $351 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $155 | $278 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $148 | $362 | $546 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $175 | $386 | $592 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $315 | $410 | $553 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $173 | $394 | $749 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $109 | $452 | $793 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $201 | $1,214 | $2,615 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $91 | $107 |
| Spirometry CPT 94010 • Pulmonology | $8 | $36 | $70 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $48 | $90 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $66 | $137 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $39 | $85 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $70 | $145 | $337 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $27 | $70 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $30 | $70 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $13 | $63 | $125 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $29 | $53 | $98 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $8 | $58 | $123 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $0 | $3 | $9 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $15 | $30 | $55 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $72 | $108 | $165 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $108 | $162 | $235 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $160 | $246 | $361 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $149 | $321 | $589 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $312 | $591 | $1,106 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $229 | $776 | $1,339 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $34 | $70 | $146 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $401 | $1,817 | $4,190 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $127 | $188 | $323 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $45 | $105 | $143 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,061 | $1,353 | $1,571 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $1,397 | $1,681 | $1,993 |
| IMRT delivery simple CPT 77385 • Radiation Therapy | $370 | $440 | $510 |
| IMRT delivery complex CPT 77386 • Radiation Therapy | $370 | $574 | $839 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $101 | $195 | $258 |