PROVIDENCE HOLY FAMILY HOSPITAL
Acute Care Hospitals
Procedure Prices at PROVIDENCE HOLY FAMILY HOSPITAL
HC LEGAL BLOOD COLLECTION
CPT 36415
$39.2
Mechanical Traction
CPT 97012
$67.2
Therapeutic Activities
CPT 97530
$69.3
HC CBC WITH DIFF AUTO
CPT 85025
$76.3
Therapeutic Exercises
CPT 97110
$81.2
HC COMPREHEN METABOLIC PANEL
CPT 80053
$171.5
HC 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES
CPT 90837
$184.1
EKG Tracing
CPT 93005
$191.8
Chest X-Ray (1 view)
CPT 71045
$261.8
HC ESTAB PT VISIT - LEVEL 3
CPT 99213
$285.6
Chest X-Ray (2 views)
CPT 71046
$411.6
Diagnostic Mammogram (unilateral)
CPT 77065
$425.6
ER Visit — Low-Moderate Complexity
CPT 99283
$646.8
Diagnostic Mammogram (bilateral)
CPT 77066
$658
Thoracic Spine X-Ray
CPT 72072
$740.6
OB Ultrasound
CPT 76805
$996.8
Abdominal Ultrasound — Limited
CPT 76705
$998.2
CT Chest
CPT 71250
$1,038.1
ER Visit — Moderate Complexity
CPT 99284
$1,040.2
HC INJ FORAMEN EPIDURAL L/S
CPT 64483
$1,117.2
Echocardiogram w/ Doppler
CPT 93306
$1,291.5
Retroperitoneal Ultrasound
CPT 76770
$1,320.2
Abdominal Ultrasound
CPT 76700
$1,530.9
ER Visit — High Complexity
CPT 99285
$2,305.8
MRI Brain w/o Contrast
CPT 70551
$2,401.7
MRI Joint of Lower Extremity
CPT 73721
$2,808.4
MRI Brain w/ Contrast
CPT 70553
$3,311
CT Abdomen & Pelvis
CPT 74177
$5,147.1
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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.