NOVANT HEALTH MIDTOWN OUTPATIENT SURGERY, LLC· CHARLOTTE, NC

Ambulatory surgery center

1918 RANDOLPH RD STE 740, CHARLOTTE, NC 28207

Procedures offered

947 total

Procedure	Min	Avg	Max
Immunization admin injection each additional CPT 90472 • Preventive Care	$26	$26	$26
HPV vaccine 9-valent CPT 90651 • Preventive Care	$368	$368	$368
Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care	$257	$268	$289
Rotavirus vaccine pentavalent CPT 90680 • Preventive Care	$114	$114	$114
Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care	$24	$24	$24
MMR vaccine CPT 90707 • Preventive Care	$108	$108	$108
Tdap vaccine age 7 years or older CPT 90715 • Preventive Care	$59	$59	$59
Varicella vaccine CPT 90716 • Preventive Care	$215	$215	$215
Pneumococcal vaccine adult CPT 90732 • Preventive Care	$133	$137	$141
Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care	$282	$282	$282
Preventive visit new patient infant CPT 99381 • Preventive Care	$106	$153	$200
Preventive visit new patient age 1-4 CPT 99382 • Preventive Care	$210	$210	$210
Preventive visit new patient age 5-11 CPT 99383 • Preventive Care	$61	$61	$61
Preventive visit new patient age 12-17 CPT 99384 • Preventive Care	$99	$159	$248
Preventive visit new patient age 18-39 CPT 99385 • Preventive Care	$240	$240	$240
Preventive visit new patient age 40-64 CPT 99386 • Preventive Care	$115	$197	$278
Preventive visit new patient age 65+ CPT 99387 • Preventive Care	$92	$92	$92
Preventive visit established patient infant CPT 99391 • Preventive Care	$67	$124	$181
Preventive visit established patient age 1-4 CPT 99392 • Preventive Care	$192	$192	$192
Preventive visit established patient age 5-11 CPT 99393 • Preventive Care	$53	$77	$101
Preventive visit established patient age 12-17 CPT 99394 • Preventive Care	$160	$160	$160
Preventive visit established patient age 18-39 CPT 99395 • Preventive Care	$82	$103	$114
Preventive visit established patient age 40-64 CPT 99396 • Preventive Care	$69	$95	$122
Preventive visit established patient age 65+ CPT 99397 • Preventive Care	$77	$103	$132
Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care	$32	$32	$32
Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care	$54	$203	$353
Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care	$338	$505	$673
Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care	$674	$674	$674
Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care	$88	$144	$163
Annual wellness visit initial HCPCS G0438 • Preventive Care	$163	$211	$307
Annual wellness visit subsequent HCPCS G0439 • Preventive Care	$109	$121	$127
Bronchoscopy diagnostic CPT 31622 • Pulmonology	$243	$260	$276
Bronchoscopy with brushing CPT 31623 • Pulmonology	$387	$387	$387
Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology	$30	$214	$359
Bronchoscopy with biopsy CPT 31625 • Pulmonology	$383	$383	$383
Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology	$455	$455	$455
Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology	$2,213	$2,213	$2,213
Ventilation assist and management initiation CPT 94002 • Pulmonology	$79	$87	$91
Spirometry CPT 94010 • Pulmonology	$17	$22	$26
Spirometry before and after bronchodilator CPT 94060 • Pulmonology	$89	$89	$89
Bronchospasm provocation evaluation CPT 94070 • Pulmonology	$26	$26	$26
Respiratory flow volume loop CPT 94375 • Pulmonology	$19	$24	$30
Cardiopulmonary exercise test CPT 94621 • Pulmonology	$144	$144	$144
Nebulizer inhalation treatment CPT 94640 • Pulmonology	$30	$32	$34
Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology	$12	$14	$16
Plethysmography lung volumes CPT 94726 • Pulmonology	$25	$39	$52
Gas dilution lung volumes CPT 94727 • Pulmonology	$42	$57	$86
Diffusing capacity (DLCO) CPT 94729 • Pulmonology	$92	$92	$92
Pulse oximetry single measurement CPT 94760 • Pulmonology	$5	$5	$5
Pulse oximetry continuous overnight CPT 94762 • Pulmonology	$25	$34	$51