HOLTON COMMUNITY HOSPITAL
Critical Access Hospitals
16
Procedure Prices at HOLTON COMMUNITY HOSPITAL
39572Y - DROPOFF - SITE CODE - OIO
CPT 36415
$1.4
CBC AUTOMATED
CPT 85025
$13.23
CMP
CPT 80053
$22.46
CLINIC-EST PATIENT
CPT 99213
$24.9
EKG Interpretation
CPT 93010
$27.3
Mechanical Traction
CPT 97012
$27.41
EKG
CPT 93000
$30.63
Therapeutic Activities
CPT 97530
$33.55
Therapeutic Exercises
CPT 97110
$34.21
EKG Tracing
CPT 93005
$74.56
Diagnostic Mammogram (unilateral)
CPT 77065
$81.14
Diagnostic Mammogram (bilateral)
CPT 77066
$81.14
Screening Mammogram (bilateral)
CPT 77067
$81.14
Chest X-Ray (1 view)
CPT 71045
$90.79
Chest X-Ray (2 views)
CPT 71046
$108.55
ER Visit — Low-Moderate Complexity
CPT 99283
$109.2
Abdominal Ultrasound — Limited
CPT 76705
$116
OB Ultrasound
CPT 76805
$131
Psychotherapy, 1 hour
CPT 90837
$149.69
Abdominal Ultrasound
CPT 76700
$150
Retroperitoneal Ultrasound
CPT 76770
$150
MRI Brain w/ Contrast
CPT 70553
$184.38
Thoracic Spine X-Ray
CPT 72072
$189.69
ER Visit — Moderate Complexity
CPT 99284
$205.5
Upper GI Endoscopy w/ Biopsy
CPT 43239
$208.65
Appendectomy
CPT 44950
$208.65
Colonoscopy
CPT 45378
$208.65
Colonoscopy w/ Biopsy
CPT 45380
$208.65
Vaginal Delivery
CPT 59400
$208.65
C-Section
CPT 59510
$208.65
ER Visit — High Complexity
CPT 99285
$208.65
CT Chest
CPT 71250
$453
CT Abdomen & Pelvis
CPT 74177
$453
MRI Brain w/o Contrast
CPT 70551
$518.43
MRI Joint of Lower Extremity
CPT 73721
$518.43
Echocardiogram w/ Doppler
CPT 93306
$998.03
Knee Replacement
CPT 27447
$1,010
Laparoscopic Cholecystectomy
CPT 47562
$1,010
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$1,223.26
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$1,242.33
Cataract Surgery — Complex
CPT 66982
$1,599.57
Inguinal Hernia Repair
CPT 49505
$2,317.56
Knee Arthroscopy
CPT 29881
$2,334.01
OR ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
CPT 29827
$4,073.28
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.