ONSLOW MEMORIAL HOSPITAL· JACKSONVILLE, NC

HospitalCMS 1/5

317 WESTERN BOULEVARD, JACKSONVILLE, NC 28546

Procedures offered

935 total

ProcedureMinAvgMax
MRI thoracic spine without contrast
CPT 72146 • Imaging
$134$239$433
MRI lumbar spine without contrast
CPT 72148 • Imaging
$131$263$510
X-ray shoulder complete
CPT 73030 • Imaging
$21$31$43
MRI joint upper extremity without contrast
CPT 73221 • Imaging
$73$228$456
X-ray knee 1-2 views
CPT 73560 • Imaging
$9$26$43
X-ray ankle complete
CPT 73610 • Imaging
$25$32$45
MRI lower extremity without contrast
CPT 73718 • Imaging
$72$235$456
MRI joint lower extremity without contrast
CPT 73721 • Imaging
$73$285$456
CT abdomen without contrast
CPT 74150 • Imaging
$64$178$257
CT abdomen and pelvis without contrast
CPT 74176 • Imaging
$94$170$212
CT abdomen and pelvis with contrast
CPT 74177 • Imaging
$98$241$333
CT abdomen and pelvis without then with contrast
CPT 74178 • Imaging
$108$283$370
Ultrasound abdominal complete
CPT 76700 • Imaging
$38$77$109
Ultrasound retroperitoneal complete
CPT 76770 • Imaging
$105$123$148
Ultrasound transvaginal
CPT 76830 • Imaging
$37$80$160
Ultrasound pelvic complete
CPT 76856 • Imaging
$42$78$113
Diagnostic mammography unilateral
CPT 77065 • Imaging
$94$112$133
Diagnostic mammography bilateral
CPT 77066 • Imaging
$50$118$169
Screening mammography bilateral
CPT 77067 • Imaging
$38$105$141
Nuclear myocardial perfusion study
CPT 78452 • Imaging
$336$369$411
Urinalysis non-automated without microscopy
CPT 81002 • Lab
$1$2$2
Basic metabolic panel
CPT 80048 • Laboratory
$3$10$23
Comprehensive metabolic panel
CPT 80053 • Laboratory
$6$6$6
Lipid panel
CPT 80061 • Laboratory
$7$18$36
Hepatic function panel
CPT 80076 • Laboratory
$3$10$22
Urinalysis with microscopy
CPT 81001 • Laboratory
$1$2$2
Urinalysis automated without microscopy
CPT 81003 • Laboratory
$1$1$2
Fecal hemoglobin immunoassay
CPT 82274 • Laboratory
$8$17$32
Vitamin D 25-hydroxy
CPT 82306 • Laboratory
$16$38$81
Creatine kinase (CK) total
CPT 82550 • Laboratory
$2$8$18
Creatinine urine
CPT 82570 • Laboratory
$3$7$14
Ferritin
CPT 82728 • Laboratory
$4$16$37
IgA IgD IgG IgM each
CPT 82784 • Laboratory
$5$12$25
Glucose quantitative blood
CPT 82947 • Laboratory
$2$3$3
Hemoglobin A1c
CPT 83036 • Laboratory
$3$7$11
Iron serum
CPT 83540 • Laboratory
$2$4$8
Iron binding capacity
CPT 83550 • Laboratory
$3$6$10
Prostate specific antigen (PSA)
CPT 84153 • Laboratory
$6$22$50
Free thyroxine (T4)
CPT 84439 • Laboratory
$5$12$25
Thyroid stimulating hormone (TSH)
CPT 84443 • Laboratory
$9$22$46
Complete blood count with differential
CPT 85025 • Laboratory
$4$6$9
Complete blood count automated
CPT 85027 • Laboratory
$2$3$4
Prothrombin time (PT)
CPT 85610 • Laboratory
$1$3$5
Sedimentation rate (ESR) automated
CPT 85652 • Laboratory
$1$2$3
Partial thromboplastin time (PTT)
CPT 85730 • Laboratory
$3$8$16
Cyclic citrullinated peptide antibody
CPT 86200 • Laboratory
$6$15$35
Nuclear antigen antibody
CPT 86235 • Laboratory
$6$21$49
Heterophile antibodies screen
CPT 86308 • Laboratory
$3$4$6
TB skin test intradermal
CPT 86580 • Laboratory
$3$4$6
Blood typing ABO
CPT 86900 • Laboratory
$1$4$8