MARY IMMACULATE HOSPITAL
Hospital
Procedure Prices at MARY IMMACULATE HOSPITAL
Routine Venipuncture
CPT 36415
$2.7
Cbc With Auto Diff
CPT 85025
$6.99
Comprehen Metabolic Panel
CPT 80053
$9.5
Chest X-Ray (1 view)
CPT 71045
$16.22
EKG Tracing
CPT 93005
$16.22
Mechanical Traction
CPT 97012
$27
Chest X-Ray (2 views)
CPT 71046
$29.91
Thoracic Spine X-Ray
CPT 72072
$38.03
Therapeutic Exercises
CPT 97110
$54.6
Therapeutic Activities
CPT 97530
$70.25
Estab Pt Level III
CPT 99213
$92.78
Abdominal Ultrasound — Limited
CPT 76705
$106.98
Screening Mammogram (bilateral)
CPT 77067
$121.2
Diagnostic Mammogram (unilateral)
CPT 77065
$134.36
Diagnostic Mammogram (bilateral)
CPT 77066
$134.36
Echocardiogram
CPT 93307
$148.55
Psych Tx 60 Min W/Pt
CPT 90837
$185.56
Echocardiogram w/ Doppler
CPT 93306
$227.64
Inj(S) Anes/Steroid Epi Lumb Sng W Imag
CPT 64483
$242.85
Retroperitoneal Ultrasound
CPT 76770
$283.41
ER Visit — Low-Moderate Complexity
CPT 99283
$319.41
OB Ultrasound
CPT 76805
$360.48
Abdominal Ultrasound
CPT 76700
$431.96
ER Visit — Moderate Complexity
CPT 99284
$473.03
CT Chest
CPT 71250
$697
CT Abdomen & Pelvis
CPT 74177
$697
ER Visit — High Complexity
CPT 99285
$751.88
MRI Brain w/o Contrast
CPT 70551
$1,194
MRI Brain w/ Contrast
CPT 70553
$1,194
MRI Joint of Lower Extremity
CPT 73721
$1,194
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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.