DLP PERSON MEMORIAL HOSPITAL LLC· ROXBORO, NC
Hospital
615 RIDGE RD, ROXBORO, NC 27573
Procedures offered
968 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Gait training each 15 minutes CPT 97116 • Physical Therapy | $12 | $38 | $68 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $13 | $36 | $62 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $9 | $26 | $43 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $59 | $158 | $235 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $59 | $158 | $235 |
| Physical therapy evaluation high complexity CPT 97163 • Physical Therapy | $59 | $158 | $235 |
| Physical therapy re-evaluation CPT 97164 • Physical Therapy | $45 | $86 | $158 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $14 | $46 | $85 |
| Self-care/home management training each 15 min CPT 97535 • Physical Therapy | $18 | $43 | $75 |
| Wheelchair management training each 15 minutes CPT 97542 • Physical Therapy | $14 | $46 | $78 |
| Physical performance test each 15 minutes CPT 97750 • Physical Therapy | $16 | $41 | $83 |
| Orthotic management and training each 15 min CPT 97760 • Physical Therapy | $19 | $59 | $110 |
| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $16 | $54 | $95 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $31 | $61 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $15 | $29 |
| Immunization admin injection single CPT 90471 • Preventive Care | $19 | $32 | $61 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $18 | $29 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $314 | $390 | $537 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $232 | $288 | $405 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $101 | $123 | $167 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $118 | $160 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $53 | $67 |
| Varicella vaccine CPT 90716 • Preventive Care | $187 | $230 | $313 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $120 | $149 | $208 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $266 | $352 |
| Genetic counseling 30 minutes CPT 96040 • Preventive Care | $143 | $143 | $143 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $70 | $189 | $291 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $94 | $161 | $304 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $97 | $220 | $317 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $111 | $183 | $355 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $79 | $180 | $344 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $96 | $259 | $398 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $134 | $227 | $432 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $56 | $128 | $261 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $86 | $147 | $278 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $98 | $150 | $277 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $158 | $283 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $71 | $154 | $310 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $118 | $238 | $362 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $83 | $138 | $168 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $0 | $42 | $94 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $1,500 | $6,953 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $153 | $1,672 | $6,953 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $164 | $1,699 | $6,953 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $159 | $232 | $402 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $182 | $250 | $414 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $104 | $160 | $282 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $78 | $1,765 | $6,953 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $262 | $1,728 | $6,953 |