PROVIDENCE KODIAK ISLAND MEDICAL CTR
Critical Access Hospitals
16
Procedure Prices at PROVIDENCE KODIAK ISLAND MEDICAL CTR
HC ED ROUTINE VENIPUNCTURE OR LEGAL DRAW CDM
CPT 36415
$84.8
Mechanical Traction
CPT 97012
$140.8
Therapeutic Exercises
CPT 97110
$140.8
Therapeutic Activities
CPT 97530
$140.8
HC CBC WITH DIFF AUTO
CPT 85025
$220
HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES
CPT 90837
$267.2
ESTAB PT VISIT - LEVEL 3
CPT 99213
$290.4
Diagnostic Mammogram (unilateral)
CPT 77065
$396
HC COMPREHEN METABOLIC PANEL
CPT 80053
$400.8
Echocardiogram w/ Doppler
CPT 93306
$419.2
Screening Mammogram (bilateral)
CPT 77067
$520.8
Diagnostic Mammogram (bilateral)
CPT 77066
$591.2
Chest X-Ray (1 view)
CPT 71045
$602.4
Thoracic Spine X-Ray
CPT 72072
$629.6
Abdominal Ultrasound — Limited
CPT 76705
$639.2
Chest X-Ray (2 views)
CPT 71046
$665.6
EKG Tracing
CPT 93005
$697.6
ER Visit — Moderate Complexity
CPT 99284
$731.2
EKG
CPT 93000
$800
OB Ultrasound
CPT 76805
$952.8
Retroperitoneal Ultrasound
CPT 76770
$1,127.2
ER Visit — Low-Moderate Complexity
CPT 99283
$1,246.4
HC PR 64483 NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL
CPT 64483
$1,400.8
Abdominal Ultrasound
CPT 76700
$1,492.8
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$1,696.8
Colonoscopy
CPT 45378
$1,807.2
Upper GI Endoscopy w/ Biopsy
CPT 43239
$1,929.6
Colonoscopy w/ Biopsy
CPT 45380
$2,071.2
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$2,519.2
Laparoscopic Hernia Repair
CPT 49650
$2,577.6
MRI Joint of Lower Extremity
CPT 73721
$2,884.8
CT Chest
CPT 71250
$2,993.6
Recurrent Inguinal Hernia Repair
CPT 49520
$3,052.8
CT Abdomen & Pelvis
CPT 74177
$3,108
MRI Brain w/o Contrast
CPT 70551
$3,450.4
Inguinal Hernia Repair
CPT 49505
$3,836.8
ER Visit — High Complexity
CPT 99285
$3,914.4
Knee Arthroscopy
CPT 29881
$4,284.8
Appendectomy
CPT 44950
$4,405.6
MRI Brain w/ Contrast
CPT 70553
$4,796
Vaginal Delivery
CPT 59400
$5,766.4
HC PR 29827 ARTHROSCOP ROTATOR CUFF REPR
CPT 29827
$5,862.4
HC PR 27245 TX FEMORAL FRACTURE W/INTRAMEDULARY TYPE IMPLANT
CPT 27245
$5,982.4
Laparoscopic Cholecystectomy
CPT 47562
$6,889.6
C-Section
CPT 59510
$7,004
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.