PROVIDENCE HOLY CROSS MEDICAL CENTER
Acute Care Hospitals
Procedure Prices at PROVIDENCE HOLY CROSS MEDICAL CENTER
HC ROUTINE VENIPUNCTURE - COLLECTION VENOUS BLD
CPT 36415
$15
Mechanical Traction
CPT 97012
$53.5
Therapeutic Exercises
CPT 97110
$53.5
Therapeutic Activities
CPT 97530
$53.5
HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC #
CPT 85025
$76.75
Screening Mammogram (bilateral)
CPT 77067
$89.25
Chest X-Ray (1 view)
CPT 71045
$121.75
EKG Tracing
CPT 93005
$131.75
Diagnostic Mammogram (unilateral)
CPT 77065
$136.25
Diagnostic Mammogram (bilateral)
CPT 77066
$194.25
Chest X-Ray (2 views)
CPT 71046
$215.75
Abdominal Ultrasound — Limited
CPT 76705
$229.5
HC COMPREHEN METABOLIC PANEL
CPT 80053
$296.75
Thoracic Spine X-Ray
CPT 72072
$302.5
HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM
CPT 99213
$332
Retroperitoneal Ultrasound
CPT 76770
$359
OB Ultrasound
CPT 76805
$388.75
Abdominal Ultrasound
CPT 76700
$418.75
ER Visit — Low-Moderate Complexity
CPT 99283
$434.75
HC INJ FORAMEN EPIDURAL L/S
CPT 64483
$452.5
ER Visit — Moderate Complexity
CPT 99284
$578.5
ER Visit — High Complexity
CPT 99285
$863.5
MRI Joint of Lower Extremity
CPT 73721
$983.5
CT Chest
CPT 71250
$1,127.25
Echocardiogram w/ Doppler
CPT 93306
$1,210.25
MRI Brain w/o Contrast
CPT 70551
$1,304
CT Abdomen & Pelvis
CPT 74177
$1,960
MRI Brain w/ Contrast
CPT 70553
$1,980
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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.