PROVIDENCE SEASIDE HOSPITAL
Critical Access Hospitals
Procedure Prices at PROVIDENCE SEASIDE HOSPITAL
EKG Tracing
CPT 93005
$17.25
HC BLOOD DRAW VENIPUNCTURE
CPT 36415
$20.25
EKG Interpretation
CPT 93010
$21.75
EKG
CPT 93000
$39
HC COMPLETE CBC W/AUTO DIFF WBC
CPT 85025
$51.75
HC COMPREHEN METABOLIC PANEL
CPT 80053
$63.75
Thoracic Spine X-Ray
CPT 72072
$102.75
Mechanical Traction
CPT 97012
$105
Therapeutic Exercises
CPT 97110
$105.75
Therapeutic Activities
CPT 97530
$128.25
Chest X-Ray (1 view)
CPT 71045
$131.25
Chest X-Ray (2 views)
CPT 71046
$186
ER Visit — Low-Moderate Complexity
CPT 99283
$188.25
HC L&D TRIAGE ESTAB PATIENT LVL 3 CDM
CPT 99213
$221.25
Diagnostic Mammogram (unilateral)
CPT 77065
$252.75
Screening Mammogram (bilateral)
CPT 77067
$273.75
ER Visit — Moderate Complexity
CPT 99284
$319.5
Diagnostic Mammogram (bilateral)
CPT 77066
$356.25
OB Ultrasound
CPT 76805
$369
Echocardiogram
CPT 93307
$378.75
HC PR 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES
CPT 90837
$393
Abdominal Ultrasound — Limited
CPT 76705
$455.25
ER Visit — High Complexity
CPT 99285
$466.5
Abdominal Ultrasound
CPT 76700
$511.5
Retroperitoneal Ultrasound
CPT 76770
$522.75
Echocardiogram w/ Doppler
CPT 93306
$536.25
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$759.75
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$793.5
Colonoscopy
CPT 45378
$921
Upper GI Endoscopy w/ Biopsy
CPT 43239
$1,034.25
Laparoscopic Hernia Repair
CPT 49650
$1,151.25
Colonoscopy w/ Biopsy
CPT 45380
$1,191
MRI Joint of Lower Extremity
CPT 73721
$1,259.25
MRI Brain w/o Contrast
CPT 70551
$1,342.5
Inguinal Hernia Repair
CPT 49505
$1,353.75
Knee Arthroscopy
CPT 29881
$1,443.75
CT Abdomen & Pelvis
CPT 74177
$1,649.25
CT Chest
CPT 71250
$1,671
Recurrent Inguinal Hernia Repair
CPT 49520
$1,686.75
Appendectomy
CPT 44950
$1,711.5
Laparoscopic Cholecystectomy
CPT 47562
$1,758.75
HC PR 29827 ARTHROSCOP ROTATOR CUFF REPR
CPT 29827
$2,838.75
MRI Brain w/ Contrast
CPT 70553
$2,867.25
HC PR 27245 TX FEMORAL FRACTURE W/INTRAMEDULARY TYPE IMPLANT
CPT 27245
$3,255
Knee Replacement
CPT 27447
$3,406.5
Hip Replacement
CPT 27130
$3,411
VBAC Delivery
CPT 59610
$5,615.25
C-Section
CPT 59510
$5,921.25
Vaginal Delivery
CPT 59400
$6,323.25
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.