DOMINION DIAGNOSTICS LLC· GREENSBORO, NC

Lab

706 GREEN VALLEY RD, GREENSBORO, NC 27408

Procedures offered

920 total

Procedure	Min	Avg	Max
Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care	$97	$140	$184
Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care	$176	$257	$338
Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care	$176	$176	$176
Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care	$86	$125	$163
Annual wellness visit initial HCPCS G0438 • Preventive Care	$129	$146	$163
Annual wellness visit subsequent HCPCS G0439 • Preventive Care	$68	$97	$127
Bronchoscopy diagnostic CPT 31622 • Pulmonology	$194	$219	$243
Bronchoscopy with brushing CPT 31623 • Pulmonology	$89	$89	$89
Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology	$13	$106	$198
Bronchoscopy with biopsy CPT 31625 • Pulmonology	$119	$234	$349
Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology	$121	$246	$371
Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology	$962	$1,120	$1,278
Ventilation assist and management initiation CPT 94002 • Pulmonology	$47	$47	$47
Spirometry CPT 94010 • Pulmonology	$10	$18	$26
Spirometry before and after bronchodilator CPT 94060 • Pulmonology	$5	$21	$37
Bronchospasm provocation evaluation CPT 94070 • Pulmonology	$33	$33	$33
Respiratory flow volume loop CPT 94375 • Pulmonology	$13	$25	$37
Cardiopulmonary exercise test CPT 94621 • Pulmonology	$80	$80	$80
Nebulizer inhalation treatment CPT 94640 • Pulmonology	$4	$4	$4
Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology	$9	$13	$16
Plethysmography lung volumes CPT 94726 • Pulmonology	$29	$41	$52
Gas dilution lung volumes CPT 94727 • Pulmonology	$23	$33	$42
Diffusing capacity (DLCO) CPT 94729 • Pulmonology	$29	$29	$29
Pulse oximetry continuous overnight CPT 94762 • Pulmonology	$13	$19	$25
Radiation therapy planning simple CPT 77261 • Radiation Therapy	$55	$55	$55
Radiation therapy planning intermediate CPT 77262 • Radiation Therapy	$56	$56	$56
Radiation therapy planning complex CPT 77263 • Radiation Therapy	$130	$147	$165
Radiation therapy simulation simple CPT 77280 • Radiation Therapy	$19	$138	$257
Radiation therapy simulation complex CPT 77290 • Radiation Therapy	$190	$190	$190
3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy	$116	$116	$116
Radiation therapy dose calculation CPT 77300 • Radiation Therapy	$17	$40	$63
IMRT radiation therapy plan CPT 77301 • Radiation Therapy	$1,436	$1,592	$1,747
Radiation treatment device design complex CPT 77334 • Radiation Therapy	$34	$77	$120
Radiation physics consultation CPT 77336 • Radiation Therapy	$69	$73	$78
Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy	$815	$937	$1,059
Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy	$516	$740	$964
Radiation treatment delivery superficial CPT 77407 • Radiation Therapy	$97	$97	$97
Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy	$172	$172	$172
Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy	$148	$167	$186
Radiation therapy management complete course CPT 77431 • Radiation Therapy	$84	$94	$104
Proton beam treatment simple CPT 77520 • Radiation Therapy	$233	$532	$831
Proton beam treatment complex CPT 77523 • Radiation Therapy	$406	$687	$968
Polysomnography under age 6 CPT 95782 • Sleep Medicine	$445	$606	$768
Polysomnography under age 6 with CPAP CPT 95783 • Sleep Medicine	$470	$642	$813
Sleep study unattended CPT 95800 • Sleep Medicine	$71	$71	$71
Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine	$21	$48	$75
Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine	$195	$267	$339
Polysomnography age 6 or older CPT 95810 • Sleep Medicine	$324	$409	$495
Polysomnography with CPAP titration CPT 95811 • Sleep Medicine	$276	$276	$276
CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine	$154	$154	$154