ONSLOW MEMORIAL HOSPITAL INC· JACKSONVILLE, NC

HospitalCMS 1/5

317 WESTERN BLVD, JACKSONVILLE, NC 28546

Procedures offered

954 total

ProcedureMinAvgMax
IgA IgD IgG IgM each
CPT 82784 • Laboratory
$5$10$25
Glucose quantitative blood
CPT 82947 • Laboratory
$2$4$5
Hemoglobin A1c
CPT 83036 • Laboratory
$3$8$13
Iron serum
CPT 83540 • Laboratory
$2$6$9
Iron binding capacity
CPT 83550 • Laboratory
$3$7$10
Prostate specific antigen (PSA)
CPT 84153 • Laboratory
$6$21$50
Free thyroxine (T4)
CPT 84439 • Laboratory
$5$11$25
Thyroid stimulating hormone (TSH)
CPT 84443 • Laboratory
$3$17$46
Complete blood count with differential
CPT 85025 • Laboratory
$4$7$10
Complete blood count automated
CPT 85027 • Laboratory
$2$5$9
Prothrombin time (PT)
CPT 85610 • Laboratory
$1$4$5
Sedimentation rate (ESR) automated
CPT 85652 • Laboratory
$1$2$4
Partial thromboplastin time (PTT)
CPT 85730 • Laboratory
$3$7$16
Cyclic citrullinated peptide antibody
CPT 86200 • Laboratory
$6$14$35
Nuclear antigen antibody
CPT 86235 • Laboratory
$6$20$49
Heterophile antibodies screen
CPT 86308 • Laboratory
$3$5$7
TB skin test intradermal
CPT 86580 • Laboratory
$3$7$8
Blood typing ABO
CPT 86900 • Laboratory
$1$3$8
Blood typing Rh
CPT 86901 • Laboratory
$1$3$8
Urine culture bacterial colony count
CPT 87086 • Laboratory
$4$7$11
Chlamydia nucleic acid amplification
CPT 87491 • Laboratory
$20$37$90
Gonorrhea nucleic acid amplification
CPT 87591 • Laboratory
$20$40$90
SARS-CoV-2 COVID-19 amplified probe
CPT 87635 • Laboratory
$13$41$56
Influenza virus assay with direct optical
CPT 87804 • Laboratory
$7$11$14
Strep A assay with optic observation
CPT 87880 • Laboratory
$12$12$12
Amniocentesis diagnostic
CPT 59000 • Maternity
$70$112$146
Cordocentesis fetal blood sampling
CPT 59012 • Maternity
$30$187$283
Chorionic villus sampling
CPT 59015 • Maternity
$162$187$277
Fetal non-stress test
CPT 59025 • Maternity
$37$57$103
Insertion cervical dilator
CPT 59200 • Maternity
$47$77$103
Vaginal delivery including prenatal and postpartum care
CPT 59400 • Maternity
$2,200$2,487$3,403
Vaginal delivery only
CPT 59409 • Maternity
$721$856$1,123
Vaginal delivery including postpartum care
CPT 59410 • Maternity
$807$1,223$2,550
External cephalic version
CPT 59412 • Maternity
$91$102$108
Antepartum care 7 or more visits
CPT 59426 • Maternity
$50$935$2,171
Postpartum care only
CPT 59430 • Maternity
$118$199$324
Cesarean delivery including prenatal and postpartum care
CPT 59510 • Maternity
$45$1,941$2,388
Cesarean delivery only
CPT 59514 • Maternity
$204$795$961
Cesarean delivery including postpartum care
CPT 59515 • Maternity
$964$1,443$2,550
Vaginal delivery after prior cesarean (VBAC) including prenatal
CPT 59610 • Maternity
$2,250$2,494$3,575
Obstetric ultrasound first trimester
CPT 76801 • Maternity
$46$99$143
Obstetric ultrasound complete
CPT 76805 • Maternity
$54$109$159
Obstetric ultrasound detailed fetal anatomy
CPT 76811 • Maternity
$81$131$209
Obstetric ultrasound limited
CPT 76815 • Maternity
$35$68$110
Ultrasound transvaginal obstetric
CPT 76817 • Maternity
$44$73$108
Interactive complexity add-on
CPT 90785 • Mental Health
$5$15$18
Psychiatric diagnostic evaluation
CPT 90791 • Mental Health
$133$154$182
Psychiatric diagnostic evaluation with medical services
CPT 90792 • Mental Health
$137$166$190
Psychotherapy 30 minutes
CPT 90832 • Mental Health
$56$72$83
Psychotherapy 30 min add-on to E/M
CPT 90833 • Mental Health
$47$75$94