DELTA MEMORIAL HOSPITAL
Critical Access Hospitals
16
Procedure Prices at DELTA MEMORIAL HOSPITAL
VENIPUNCTURE
CPT 36415
$4.47
EKG Interpretation
CPT 93010
$8.84
CHARGE CBC W/A DIFF
CPT 85025
$9.23
CMP
CPT 80053
$12.52
EKG Tracing
CPT 93005
$17
Therapeutic Exercises
CPT 97110
$21.76
Therapeutic Activities
CPT 97530
$43.65
Mechanical Traction
CPT 97012
$63
PF PAIN MGMT EST PT LVL 3 (20-29 MINS)
CPT 99213
$71.74
ER Visit — Low-Moderate Complexity
CPT 99283
$76.47
Chest X-Ray (1 view)
CPT 71045
$79.7
Chest X-Ray (2 views)
CPT 71046
$102.56
Thoracic Spine X-Ray
CPT 72072
$112.1
Diagnostic Mammogram (unilateral)
CPT 77065
$128.76
ER Visit — Moderate Complexity
CPT 99284
$130.18
Upper GI Endoscopy w/ Biopsy
CPT 43239
$142.2
Abdominal Ultrasound — Limited
CPT 76705
$146.25
Diagnostic Mammogram (bilateral)
CPT 77066
$163.27
OB Ultrasound
CPT 76805
$168.35
Screening Mammogram (bilateral)
CPT 77067
$175.43
CT Chest
CPT 71250
$184.56
Colonoscopy
CPT 45378
$189.45
ER Visit — High Complexity
CPT 99285
$189.58
Abdominal Ultrasound
CPT 76700
$233.17
CT Abdomen & Pelvis
CPT 74177
$263.52
RHC PSYCHOTHERAPY 60 MIN WITH PATIENT
CPT 90837
$294.21
Laparoscopic Cholecystectomy
CPT 47562
$363
Echocardiogram w/ Doppler
CPT 93306
$447.17
Inguinal Hernia Repair
CPT 49505
$524.25
Appendectomy
CPT 44950
$648
MRI Brain w/o Contrast
CPT 70551
$733.29
MRI Joint of Lower Extremity
CPT 73721
$733.29
Recurrent Inguinal Hernia Repair
CPT 49520
$799.66
PAIN MGMT INJ ANSTH TRANS EPI LUM SGL LV
CPT 64483
$1,096.15
MRI Brain w/ Contrast
CPT 70553
$1,168.36
Colonoscopy w/ Biopsy
CPT 45380
$1,264.13
Vaginal Delivery
CPT 59400
$2,662.16
C-Section
CPT 59510
$2,940.37
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.