Mount Grant General Hospital
Critical Access Hospitals
16
Procedure Prices at Mount Grant General Hospital
Mechanical Traction
CPT 97012
$14
List: $151.25
Therapeutic Exercises
CPT 97110
$29
List: $270
Therapeutic Activities
CPT 97530
$36
List: $297.5
EKG Tracing
CPT 93005
$60
List: $386.25
Chest X-Ray (1 view)
CPT 71045
$88
List: $430.61
Chest X-Ray (2 views)
CPT 71046
$88
List: $501.25
Diagnostic Mammogram (unilateral)
CPT 77065
$89
List: $455.33
Screening Mammogram (bilateral)
CPT 77067
$94
List: $573.88
CT Chest
CPT 71250
$106
List: $3,209.7
Thoracic Spine X-Ray
CPT 72072
$106
List: $931.38
Abdominal Ultrasound
CPT 76700
$106
List: $1,456.88
Abdominal Ultrasound — Limited
CPT 76705
$106
List: $1,456.88
Retroperitoneal Ultrasound
CPT 76770
$106
List: $1,091.15
OB Ultrasound
CPT 76805
$106
List: $1,159.44
Diagnostic Mammogram (bilateral)
CPT 77066
$115
List: $624.67
MRI Brain w/o Contrast
CPT 70551
$243
List: $3,808.34
MRI Joint of Lower Extremity
CPT 73721
$243
List: $3,737.5
Echocardiogram
CPT 93307
$243
List: $3,327.54
ER Visit — Low-Moderate Complexity
CPT 99283
$279
List: $1,352.16
MRI Brain w/ Contrast
CPT 70553
$356
List: $5,463.41
CT Abdomen & Pelvis
CPT 74177
$356
List: $5,817.5
ER Visit — Moderate Complexity
CPT 99284
$426
List: $2,098.99
Echocardiogram w/ Doppler
CPT 93306
$558
List: $2,899.48
ER Visit — High Complexity
CPT 99285
$608
List: $3,043.97
Upper GI Endoscopy w/ Biopsy
CPT 43239
$927
List: $4,295.95
Colonoscopy
CPT 45378
$950
List: $2,904.8
Colonoscopy w/ Biopsy
CPT 45380
$1,223
List: $3,002.69
Knee Arthroscopy
CPT 29881
$3,345
List: $7,863
Inguinal Hernia Repair
CPT 49505
$3,660
List: $6,790.65
Laparoscopic Cholecystectomy
CPT 47562
$6,180
List: $27,344.7
Laparoscopic Hernia Repair
CPT 49650
$6,180
List: $10,625.5
Appendectomy
CPT 44950
$6,618
List: $7,743
Hip Replacement
CPT 27130
$13,125
List: $21,513
Knee Replacement
CPT 27447
$13,125
List: $13,113
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.