ONSLOW MEMORIAL HOSPITAL INC· JACKSONVILLE, NC

HospitalCMS 1/5

317 WESTERN BLVD, JACKSONVILLE, NC 28546

Procedures offered

954 total

ProcedureMinAvgMax
MRI brain with contrast
CPT 70552 • Imaging
$89$314$560
MRI brain without contrast then with contrast
CPT 70553 • Imaging
$116$443$990
Chest X-ray single view
CPT 71045 • Imaging
$16$22$34
Chest X-ray 2 views
CPT 71046 • Imaging
$9$22$33
CT chest without contrast
CPT 71250 • Imaging
$63$203$273
CT chest with contrast
CPT 71260 • Imaging
$113$216$348
CT chest without then with contrast
CPT 71270 • Imaging
$241$334$428
CT angiography chest
CPT 71275 • Imaging
$91$335$524
CT cervical spine without contrast
CPT 72125 • Imaging
$133$133$133
CT thoracic spine without contrast
CPT 72128 • Imaging
$186$186$186
CT lumbar spine without contrast
CPT 72131 • Imaging
$54$54$54
MRI cervical spine without contrast
CPT 72141 • Imaging
$80$355$523
MRI thoracic spine without contrast
CPT 72146 • Imaging
$134$293$523
MRI lumbar spine without contrast
CPT 72148 • Imaging
$131$331$523
CT pelvis without contrast
CPT 72192 • Imaging
$59$59$59
CT pelvis with contrast
CPT 72193 • Imaging
$63$196$329
X-ray shoulder complete
CPT 73030 • Imaging
$21$36$45
MRI joint upper extremity without contrast
CPT 73221 • Imaging
$73$265$523
X-ray knee 1-2 views
CPT 73560 • Imaging
$9$30$45
X-ray ankle complete
CPT 73610 • Imaging
$24$34$45
MRI lower extremity without contrast
CPT 73718 • Imaging
$64$227$523
MRI joint lower extremity without contrast
CPT 73721 • Imaging
$45$312$523
CT abdomen without contrast
CPT 74150 • Imaging
$64$191$275
CT abdomen with contrast
CPT 74160 • Imaging
$68$68$68
CT abdomen without then with contrast
CPT 74170 • Imaging
$75$75$75
CT abdomen and pelvis without contrast
CPT 74176 • Imaging
$94$194$235
CT abdomen and pelvis with contrast
CPT 74177 • Imaging
$98$274$376
CT abdomen and pelvis without then with contrast
CPT 74178 • Imaging
$108$354$477
Ultrasound abdominal complete
CPT 76700 • Imaging
$38$102$150
Ultrasound retroperitoneal complete
CPT 76770 • Imaging
$40$117$148
Ultrasound transvaginal
CPT 76830 • Imaging
$37$107$160
Ultrasound pelvic complete
CPT 76856 • Imaging
$42$98$138
Diagnostic mammography unilateral
CPT 77065 • Imaging
$94$127$143
Diagnostic mammography bilateral
CPT 77066 • Imaging
$50$137$182
Screening mammography bilateral
CPT 77067 • Imaging
$38$104$147
DEXA bone density study axial skeleton
CPT 77080 • Imaging
$31$31$31
Nuclear myocardial perfusion study
CPT 78452 • Imaging
$336$411$534
Collection of venous blood by venipuncture
CPT 36415 • Laboratory
$2$2$3
Basic metabolic panel
CPT 80048 • Laboratory
$3$10$23
Comprehensive metabolic panel
CPT 80053 • Laboratory
$6$9$14
Lipid panel
CPT 80061 • Laboratory
$7$16$36
Hepatic function panel
CPT 80076 • Laboratory
$3$9$22
Urinalysis with microscopy
CPT 81001 • Laboratory
$1$3$4
Urinalysis nonautomated without microscopy
CPT 81002 • Laboratory
$1$3$3
Urinalysis automated without microscopy
CPT 81003 • Laboratory
$1$2$3
Fecal hemoglobin immunoassay
CPT 82274 • Laboratory
$8$17$32
Vitamin D 25-hydroxy
CPT 82306 • Laboratory
$16$35$81
Creatine kinase (CK) total
CPT 82550 • Laboratory
$2$7$18
Creatinine urine
CPT 82570 • Laboratory
$3$6$14
Ferritin
CPT 82728 • Laboratory
$4$16$37