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COVENANT CHILDRENS HOSPITAL

Hospital

4015 22ND PLACE

LUBBOCK, TX, 79410

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Procedure Prices at COVENANT CHILDRENS HOSPITAL

HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD

CPT 36415

$14.54

Mechanical Traction

CPT 97012

$35.63

HC CBC WITH DIFF AUTO

CPT 85025

$41.94

HC COMPREHEN METABOLIC PANEL

CPT 80053

$61.54

Therapeutic Exercises

CPT 97110

$64.87

Therapeutic Activities

CPT 97530

$84.35

HC PSYCHOTH IND 60 MIN IOP CD/SA

CPT 90837

$159.25

Chest X-Ray (1 view)

CPT 71045

$169.25

Chest X-Ray (2 views)

CPT 71046

$169.25

EKG Tracing

CPT 93005

$261.27

Diagnostic Mammogram (unilateral)

CPT 77065

$272.5

Diagnostic Mammogram (bilateral)

CPT 77066

$273.9

Screening Mammogram (bilateral)

CPT 77067

$297.6

HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM

CPT 99213

$315.58

Thoracic Spine X-Ray

CPT 72072

$365.1

CT Chest

CPT 71250

$437.35

Abdominal Ultrasound

CPT 76700

$437.35

Abdominal Ultrasound — Limited

CPT 76705

$437.35

Retroperitoneal Ultrasound

CPT 76770

$437.35

ER Visit — Low-Moderate Complexity

CPT 99283

$671.06

MRI Joint of Lower Extremity

CPT 73721

$713.71

OB Ultrasound

CPT 76805

$734.18

Echocardiogram w/ Doppler

CPT 93306

$893.8

MRI Brain w/ Contrast

CPT 70553

$1,181.67

ER Visit — Moderate Complexity

CPT 99284

$1,220.83

CT Abdomen & Pelvis

CPT 74177

$1,477.45

MRI Brain w/o Contrast

CPT 70551

$1,902.54

ER Visit — High Complexity

CPT 99285

$2,311.87

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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.