MELISSA MEMORIAL HOSPITAL
Critical Access Hospitals
16
Procedure Prices at MELISSA MEMORIAL HOSPITAL
ANEMIA PROFILE, CBC
CPT 85025
$19
LAB DRAW ROUTINE VENIPUNCTURE
CPT 36415
$33.6
PF SC OFFICE VISIT EST PATIENT LVL 3
CPT 99213
$87.91
Screening Mammogram (bilateral)
CPT 77067
$95
Therapeutic Activities
CPT 97530
$100.8
Therapeutic Exercises
CPT 97110
$126.4
LAB COMP METABOLIC PANEL
CPT 80053
$144
ER Visit — Moderate Complexity
CPT 99284
$158.48
PF INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING GUIDA
CPT 64483
$158.55
Diagnostic Mammogram (unilateral)
CPT 77065
$160
Diagnostic Mammogram (bilateral)
CPT 77066
$160
Upper GI Endoscopy w/ Biopsy
CPT 43239
$181.95
EKG Tracing
CPT 93005
$208.8
Chest X-Ray (1 view)
CPT 71045
$253.6
Chest X-Ray (2 views)
CPT 71046
$285.6
OB Ultrasound
CPT 76805
$516
Abdominal Ultrasound — Limited
CPT 76705
$531.2
Retroperitoneal Ultrasound
CPT 76770
$635.2
Abdominal Ultrasound
CPT 76700
$700
Knee Arthroscopy
CPT 29881
$726.99
Laparoscopic Cholecystectomy
CPT 47562
$876.2
Colonoscopy w/ Biopsy
CPT 45380
$1,327.93
ER Visit — Low-Moderate Complexity
CPT 99283
$1,350.4
Recurrent Inguinal Hernia Repair
CPT 49520
$1,405.6
Inguinal Hernia Repair
CPT 49505
$1,658.7
Knee Replacement
CPT 27447
$1,828.62
Echocardiogram w/ Doppler
CPT 93306
$1,864
CT Chest
CPT 71250
$1,866.4
Colonoscopy
CPT 45378
$2,080
MRI Joint of Lower Extremity
CPT 73721
$2,324.8
MRI Brain w/o Contrast
CPT 70551
$2,358.4
PF ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
CPT 29827
$2,626.75
ER Visit — High Complexity
CPT 99285
$2,880.8
MRI Brain w/ Contrast
CPT 70553
$3,239.2
Hip Replacement
CPT 27130
$3,579.6
CT Abdomen & Pelvis
CPT 74177
$3,664.8
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$4,840.8
Cataract Surgery
CPT 66984
$6,143.2
Appendectomy
CPT 44950
$7,820.8
Cataract Surgery — Complex
CPT 66982
$8,057.6
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.