PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
Acute Care Hospitals
Procedure Prices at PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
Blood Draw From Vein Using Needle
CPT 36415
$1.75
Lab Test - Complete Blood Cell Count With White Blood Cell Percentage
CPT 85025
$5.04
Lab Test - Comprehensive Metabolic Panel
CPT 80053
$7.56
Mechanical Traction
CPT 97012
$14.88
Therapeutic Exercises
CPT 97110
$25.11
Chest X-Ray (2 views)
CPT 71046
$31.59
EKG Tracing
CPT 93005
$32.59
Abdominal Ultrasound — Limited
CPT 76705
$39.98
Chest X-Ray (1 view)
CPT 71045
$40.14
Screening Mammogram (bilateral)
CPT 77067
$53.33
Therapeutic Activities
CPT 97530
$60.03
Abdominal Ultrasound
CPT 76700
$65.6
Retroperitoneal Ultrasound
CPT 76770
$65.6
OB Ultrasound
CPT 76805
$65.6
ER Visit — Low-Moderate Complexity
CPT 99283
$72.82
Thoracic Spine X-Ray
CPT 72072
$116.38
Outpatient Clinic Visit Established Patient Level III
CPT 99213
$130.02
ER Visit — High Complexity
CPT 99285
$140
ER Visit — Moderate Complexity
CPT 99284
$158.72
Individual Psychotherapy Session 60 Minutes
CPT 90837
$164.45
Diagnostic Mammogram (unilateral)
CPT 77065
$165.23
Diagnostic Mammogram (bilateral)
CPT 77066
$170.71
CT Chest
CPT 71250
$216.89
MRI Brain w/o Contrast
CPT 70551
$225.99
MRI Joint of Lower Extremity
CPT 73721
$226.47
CT Abdomen & Pelvis
CPT 74177
$239.64
MRI Brain w/ Contrast
CPT 70553
$371.78
Echocardiogram w/ Doppler
CPT 93306
$522.05
Colonoscopy w/ Biopsy
CPT 45380
$571.26
Upper GI Endoscopy w/ Biopsy
CPT 43239
$632.83
Colonoscopy
CPT 45378
$708.35
Injection of Drug Into Lower Spinal Nerve Root With Imaging Guidance
CPT 64483
$827.64
Cataract Surgery
CPT 66984
$2,329.59
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$2,375.84
Knee Arthroscopy
CPT 29881
$2,581.18
Laparoscopic Cholecystectomy
CPT 47562
$2,679.62
Cataract Surgery — Complex
CPT 66982
$2,696.87
Inguinal Hernia Repair
CPT 49505
$3,021.66
Recurrent Inguinal Hernia Repair
CPT 49520
$3,253.46
Laparoscopic Hernia Repair
CPT 49650
$4,087.93
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$4,935.64
Repair of Shoulder Rotator Cuff Using Arthroscope
CPT 29827
$5,813.26
Knee Replacement
CPT 27447
$41,897.05
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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.