GASTON FAMILY HEALTH SERVICES, INC.· BELMONT, NC
ProviderClinic/Center, Federally Qualified Health Center (FQHC)
210 SCHOOL ST, BELMONT, NC 28012
Procedures offered
947 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $314 | $314 | $314 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $30 | $83 | $136 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $33 | $33 | $33 |
| Tympanostomy tube insertion CPT 69436 • ENT | $30 | $90 | $150 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $30 | $511 | $992 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,172 | $1,172 | $1,172 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $26 | $26 | $26 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $30 | $75 | $119 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $30 | $94 | $157 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $30 | $51 | $72 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $126 | $126 | $126 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $50 | $50 | $50 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $132 | $132 | $132 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $30 | $108 | $187 |
| Initial treatment first degree burn CPT 16000 • Emergency | $30 | $46 | $63 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $20 | $48 | $76 |
| Emergency department visit low severity CPT 99282 • Emergency | $32 | $54 | $76 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $73 | $75 | $78 |
| Emergency department visit high severity CPT 99284 • Emergency | $94 | $123 | $153 |
| Emergency department visit highest severity CPT 99285 • Emergency | $127 | $159 | $191 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $30 | $95 | $161 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $30 | $69 | $108 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $123 | $137 | $151 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $179 | $179 | $179 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $30 | $92 | $153 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $423 | $423 | $423 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $169 | $169 | $169 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $157 | $157 | $157 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $187 | $187 | $187 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $30 | $106 | $181 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $30 | $193 | $355 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $30 | $135 | $240 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $30 | $215 | $401 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $371 | $412 | $452 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $172 | $172 | $172 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $30 | $258 | $486 |
| Flexible sigmoidoscopy diagnostic CPT 45330 • Gastroenterology | $30 | $117 | $205 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $149 | $149 | $149 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $135 | $135 | $135 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $30 | $144 | $257 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $154 | $154 | $154 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $30 | $101 | $171 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $388 | $388 | $388 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $53 | $1,349 | $2,645 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $324 | $376 | $427 |
| Esophageal motility study CPT 91010 • Gastroenterology | $30 | $68 | $106 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $381 | $423 | $465 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $63 | $63 | $63 |
| Auto-added CPT 00102 • General | $30 | $35 | $40 |
| Auto-added CPT 00104 • General | $30 | $40 | $49 |