SIOUX CENTER HEALTH
Critical Access Hospitals
16
Procedure Prices at SIOUX CENTER HEALTH
Venipuncture
CPT 36415
$21.25
Chest X-Ray (2 views)
CPT 71046
$45.7
OB CBC W/Auto Diff
CPT 85025
$45.9
Thoracic Spine X-Ray
CPT 72072
$47.2
Chest X-Ray (1 view)
CPT 71045
$50.44
Office Visit Level 3
CPT 99213
$67.02
Diagnostic Mammogram (unilateral)
CPT 77065
$69.7
ER Visit — Low-Moderate Complexity
CPT 99283
$73.72
Therapeutic Exercises
CPT 97110
$73.95
Therapeutic Activities
CPT 97530
$74.8
Screening Mammogram (bilateral)
CPT 77067
$81.6
Psychotherapy 60 minutes
CPT 90837
$89.57
Diagnostic Mammogram (bilateral)
CPT 77066
$99.45
Abdominal Ultrasound — Limited
CPT 76705
$106.25
ER Visit — Moderate Complexity
CPT 99284
$120.83
Comprehensive Metabolic Panel
CPT 80053
$150.45
OB Ultrasound
CPT 76805
$152.93
Retroperitoneal Ultrasound
CPT 76770
$158.95
EKG Tracing
CPT 93005
$165.75
Abdominal Ultrasound
CPT 76700
$171.83
ER Visit — High Complexity
CPT 99285
$179.45
CT Chest
CPT 71250
$272.37
MRI Joint of Lower Extremity
CPT 73721
$277.86
CT Abdomen & Pelvis
CPT 74177
$372.3
MRI Brain w/o Contrast
CPT 70551
$426.7
MRI Brain w/ Contrast
CPT 70553
$457.3
Inj Foramen Epidural L/S RT
CPT 64483
$728.45
Colonoscopy
CPT 45378
$861.9
Echocardiogram w/ Doppler
CPT 93306
$915.45
Upper GI Endoscopy w/ Biopsy
CPT 43239
$926.5
Laparoscopic Hernia Repair
CPT 49650
$987.7
Colonoscopy w/ Biopsy
CPT 45380
$1,110.95
Inguinal Hernia Repair
CPT 49505
$1,247.8
Laparoscopic Cholecystectomy
CPT 47562
$1,507.05
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.