ST DOMINIC-JACKSON MEMORIAL HOSPITAL
Hospital
Procedure Prices at ST DOMINIC-JACKSON MEMORIAL HOSPITAL
HC Compl Cbc W/Plt W/Auto Diff
CPT 85025
$5.44
HC Venipuncture
CPT 36415
$5.88
HC Comprehensv Metabolic Panel
CPT 80053
$7.39
Mechanical Traction
CPT 97012
$13.6
Therapeutic Exercises
CPT 97110
$27.55
Therapeutic Activities
CPT 97530
$34.1
EKG Tracing
CPT 93005
$51.67
HC Office Visit Level III
CPT 99213
$62.28
Chest X-Ray (1 view)
CPT 71045
$78.09
Chest X-Ray (2 views)
CPT 71046
$78.09
CT Chest
CPT 71250
$96.07
Thoracic Spine X-Ray
CPT 72072
$96.07
Abdominal Ultrasound
CPT 76700
$96.07
Abdominal Ultrasound — Limited
CPT 76705
$96.07
Retroperitoneal Ultrasound
CPT 76770
$96.07
OB Ultrasound
CPT 76805
$96.07
HC Psytx Pt & /or Family 60 Min
CPT 90837
$102
Diagnostic Mammogram (unilateral)
CPT 77065
$111.91
Screening Mammogram (bilateral)
CPT 77067
$114.23
Upper GI Endoscopy w/ Biopsy
CPT 43239
$137.83
Colonoscopy w/ Biopsy
CPT 45380
$137.83
Laparoscopic Cholecystectomy
CPT 47562
$137.83
HC Inj Nerve Root Block Lumb/Sacral
CPT 64483
$137.83
Cataract Surgery
CPT 66984
$137.83
MRI Brain w/o Contrast
CPT 70551
$137.83
MRI Brain w/ Contrast
CPT 70553
$137.83
MRI Joint of Lower Extremity
CPT 73721
$137.83
CT Abdomen & Pelvis
CPT 74177
$137.83
Diagnostic Mammogram (bilateral)
CPT 77066
$137.83
Echocardiogram w/ Doppler
CPT 93306
$137.83
ER Visit — Low-Moderate Complexity
CPT 99283
$137.83
ER Visit — Moderate Complexity
CPT 99284
$137.83
ER Visit — High Complexity
CPT 99285
$144.66
Knee Replacement
CPT 27447
List: $33,918.16
Knee Arthroscopy
CPT 29881
List: $15,353.39
Colonoscopy
CPT 45378
List: $4,860.23
Inguinal Hernia Repair
CPT 49505
List: $12,145.47
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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.