PENOBSCOT VALLEY HOSPITAL
Critical Access Hospitals
16
Procedure Prices at PENOBSCOT VALLEY HOSPITAL
EKG Tracing
CPT 93005
$6.22
EKG Interpretation
CPT 93010
$7.88
Chest X-Ray (1 view)
CPT 71045
$11
.Specimen Collection Fee
CPT 36415
$11.6
Colonoscopy
CPT 45378
$12
ER Visit — High Complexity
CPT 99285
$12
Mechanical Traction
CPT 97012
$13.48
EKG
CPT 93000
$14.1
Upper GI Endoscopy w/ Biopsy
CPT 43239
$15
MRI Brain w/o Contrast
CPT 70551
$15
Diagnostic Mammogram (bilateral)
CPT 77066
$15
Therapeutic Exercises
CPT 97110
$26.09
Abdominal Ultrasound — Limited
CPT 76705
$26.18
Screening Mammogram (bilateral)
CPT 77067
$28
Chest X-Ray (2 views)
CPT 71046
$30.16
ER Visit — Low-Moderate Complexity
CPT 99283
$31
Retroperitoneal Ultrasound
CPT 76770
$32.54
Therapeutic Activities
CPT 97530
$32.67
Abdominal Ultrasound
CPT 76700
$35.76
ER Visit — Moderate Complexity
CPT 99284
$37
CT Chest
CPT 71250
$40
OB Ultrasound
CPT 76805
$44.95
.CBC Auto Diff*
CPT 85025
$60.84
CT Abdomen & Pelvis
CPT 74177
$71
Echocardiogram w/ Doppler
CPT 93306
$86
Diagnostic Mammogram (unilateral)
CPT 77065
$113.21
Comprehensive Metabolic Panel
CPT 80053
$118.25
Echocardiogram
CPT 93307
$126.24
ESTABLISHED PATIENT INTERMEDICATE PAIN M
CPT 99213
$127.97
Colonoscopy w/ Biopsy
CPT 45380
$166.85
Knee Replacement
CPT 27447
$168.97
Hip Replacement
CPT 27130
$169.31
MRI Joint of Lower Extremity
CPT 73721
$186.88
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$240.2
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$250.61
INJECTION LUMBAR OR SACRAL SINGLE LEVEL
CPT 64483
$273.18
MRI Brain w/ Contrast
CPT 70553
$290.06
Laparoscopic Hernia Repair
CPT 49650
$382.79
Inguinal Hernia Repair
CPT 49505
$458.37
Knee Arthroscopy
CPT 29881
$469.24
Appendectomy
CPT 44950
$547.58
Recurrent Inguinal Hernia Repair
CPT 49520
$548.92
Laparoscopic Cholecystectomy
CPT 47562
$570.46
OPEN ROTAR CUFF REPAIR
CPT 29827
$2,001.36
C-Section
CPT 59510
$2,049.69
TXT INTERTROCHAMERIC W INTRAMEDULLARY IM
CPT 27245
$2,296.05
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.