WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL
Critical Access Hospitals
16
Procedure Prices at WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL
COLLECTION: VENOUS DRAW
CPT 36415
$1.8
CBC W/WBC (DIFF)
CPT 85025
$6.35
COMPREHENSIVE METABOLIC PANEL
CPT 80053
$8.62
Chest X-Ray (1 view)
CPT 71045
$10.54
Mechanical Traction
CPT 97012
$14.28
EKG Tracing
CPT 93005
$16.11
Chest X-Ray (2 views)
CPT 71046
$19.43
Therapeutic Exercises
CPT 97110
$22.03
Thoracic Spine X-Ray
CPT 72072
$26.85
Therapeutic Activities
CPT 97530
$27.34
Diagnostic Mammogram (unilateral)
CPT 77065
$43.25
Screening Mammogram (bilateral)
CPT 77067
$45.7
Abdominal Ultrasound — Limited
CPT 76705
$54.16
Diagnostic Mammogram (bilateral)
CPT 77066
$55.28
Abdominal Ultrasound
CPT 76700
$58.27
Retroperitoneal Ultrasound
CPT 76770
$58.27
OB Ultrasound
CPT 76805
$58.27
CT Chest
CPT 71250
$70.79
PSYCH THERAPY 60 MINS
CPT 90837
$71.6
MRI Brain w/o Contrast
CPT 70551
$106.69
MRI Joint of Lower Extremity
CPT 73721
$106.69
CT Abdomen & Pelvis
CPT 74177
$119.95
MRI Brain w/ Contrast
CPT 70553
$144.02
Echocardiogram w/ Doppler
CPT 93306
$201.05
Upper GI Endoscopy w/ Biopsy
CPT 43239
$362.71
Colonoscopy w/ Biopsy
CPT 45380
$362.71
Colonoscopy
CPT 45378
$373.52
INJ ANES EPID LUM/SAC SGL
CPT 64483
$440.44
Appendectomy
CPT 44950
$669.21
Cataract Surgery
CPT 66984
$710.7
Cataract Surgery — Complex
CPT 66982
$837.47
Tonsillectomy & Adenoidectomy (under 12)
CPT 42820
$855.22
Tonsillectomy & Adenoidectomy (12+)
CPT 42821
$923
ARTHROSCOP ROTATOR CUFF REPR
CPT 29827
$994.17
Hip Replacement
CPT 27130
$1,029.42
Knee Arthroscopy
CPT 29881
$1,214
Inguinal Hernia Repair
CPT 49505
$1,214
Recurrent Inguinal Hernia Repair
CPT 49520
$1,214
Laparoscopic Hernia Repair
CPT 49650
$1,444.47
Laparoscopic Cholecystectomy
CPT 47562
$1,966.49
Knee Replacement
CPT 27447
$2,003.98
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.