NOVANT HEALTH FORSYTH MEDICAL CENTER· WINSTON-SALEM, NC
HospitalCMS 4/5
3333 SILAS CREEK PARKWAY, WINSTON-SALEM, NC 27103
Procedures offered
940 total
| Procedure | Min | Avg | Max |
|---|---|---|---|
| CT chest without contrast CPT 71250 • Imaging | $74 | $199 | $348 |
| CT chest with contrast CPT 71260 • Imaging | $175 | $285 | $438 |
| CT angiography chest CPT 71275 • Imaging | $279 | $437 | $663 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $102 | $419 | $944 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $135 | $430 | $944 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $75 | $392 | $944 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $34 | $77 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $94 | $306 | $599 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $32 | $46 | $77 |
| X-ray ankle complete CPT 73610 • Imaging | $12 | $40 | $83 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $261 | $545 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $94 | $398 | $944 |
| CT abdomen without contrast CPT 74150 • Imaging | $56 | $203 | $359 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $83 | $177 | $478 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $87 | $346 | $817 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $127 | $408 | $915 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $45 | $145 | $264 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $41 | $120 | $245 |
| Ultrasound transvaginal CPT 76830 • Imaging | $30 | $118 | $271 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $33 | $102 | $239 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $56 | $154 | $282 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $44 | $140 | $356 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $178 | $287 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $110 | $448 | $1,010 |
| Urinalysis non-automated without microscopy CPT 81002 • Lab | $2 | $4 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $8 | $13 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $5 | $12 | $19 |
| Lipid panel CPT 80061 • Laboratory | $9 | $14 | $25 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $8 | $12 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $5 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $3 | $5 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $8 | $19 | $30 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $17 | $33 | $51 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $5 | $7 | $10 |
| Creatinine urine CPT 82570 • Laboratory | $4 | $5 | $8 |
| Ferritin CPT 82728 • Laboratory | $7 | $21 | $50 |
| IgA IgD IgG IgM each CPT 82784 • Laboratory | $5 | $13 | $30 |
| Glucose quantitative blood CPT 82947 • Laboratory | $2 | $5 | $7 |
| Hemoglobin A1c CPT 83036 • Laboratory | $6 | $12 | $20 |
| Iron serum CPT 83540 • Laboratory | $3 | $6 | $10 |
| Iron binding capacity CPT 83550 • Laboratory | $4 | $9 | $13 |
| Prostate specific antigen (PSA) CPT 84153 • Laboratory | $9 | $22 | $30 |
| Free thyroxine (T4) CPT 84439 • Laboratory | $6 | $9 | $14 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $10 | $21 | $30 |
| Complete blood count with differential CPT 85025 • Laboratory | $5 | $8 | $12 |
| Complete blood count automated CPT 85027 • Laboratory | $4 | $6 | $10 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $3 | $5 | $8 |
| Sedimentation rate (ESR) automated CPT 85652 • Laboratory | $2 | $3 | $5 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $3 | $6 | $9 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $6 | $13 | $20 |