Top 40 services provided by SOUTHWEST MEMORIAL HOSPITAL
Services CPT Price Est. Cash Price
Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. 43235 $602.00 $0.00
Biopsy (or surgical procedure to remove tissue) for the upper digestive tract 43239 $1,358.00 $0.00
Colonoscopy, flexible; with biopsy, single or multiple 45380 $1,073.00 $0.00
Surgical removal of the gallbladder called a laparoscopic cholecystectomy 47562 $2,225.00 $0.00
CT scan of the head or brain without contrast or dye 70450 $1,390.00 $0.00
MRI scan of the brain with and without contrast 70553 $5,001.00 $0.00
X-ray of the chest, 2 views 71046 $162.00 $0.00
X-ray of the chest, 2 views 71046 $323.00 $0.00
X-ray of the chest, 2 views 71046 $198.00 $0.00
X-ray of the lower spine with 4 or more views 72110 $319.00 $0.00
CT scan of the pelvis with contrast or dye 72193 $2,005.00 $0.00
CT scan of the abdomen with contrast or dye 74160 $2,179.00 $0.00
Ultrasound of the abdomen 76700 $58.00 $0.00
Ultrasound of the abdomen 76700 $793.00 $0.00
Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples 76805 $708.00 $0.00
Mammogram of both breasts 77067 $409.00 $0.00
Mammogram of both breasts 77067 $185.00 $0.00
Basic Metabolic Panel 80048 $64.00 $0.00
Comprehensive Metabolic Panel 80053 $79.00 $0.00
Lipid Panel 80061 $100.00 $0.00
Lipid Panel 80061 $60.00 $0.00
Urinalysis, by dipstick or tablet reagent not automated without a microscope 81001 $71.00 $0.00
Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage 82550 $51.00 $0.00
Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage 82550 $124.00 $0.00
Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage 82550 $30.00 $0.00
Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. 84443 $86.00 $0.00
Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. 84443 $43.00 $0.00
Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks 84484 $104.00 $0.00
Complete blood cell count (red cells, white blood cell, platelets), automated test 85025 $51.00 $0.00
Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. 85610 $50.00 $0.00
Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. 85610 $24.00 $0.00
Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. 85610 $37.00 $0.00
Routine electrocardiogram (EKG) with tracing using at least 12 leads 93005 $471.00 $0.00
Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD 94640 $383.00 $0.00
Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD 94640 $105.00 $0.00
Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes 97110 $71.00 $0.00
Training for walking to 1 or more areas for 15 minutes 97116 $63.00 $0.00
Physical therapy evaluation session for 20 minutes 97161 $167.00 $0.00
Office visit for an established patient (moderate severity) typically 15 minutes 99213 $129.00 $0.00
Office visit for an established patient (moderate severity) typically 15 minutes 99213 $129.00 $0.00
Emergency department visit facility fees for a visit of moderate severity 99283 $769.00 $0.00
Emergency department visit facility fees for a visit of moderate severity 99283 $240.00 $0.00
Emergency department visit facility fees for a visit of moderate severity 99283 $364.00 $0.00
Emergency department visit facility fees for a visit of high to moderate severity 99284 $1,033.00 $0.00
Emergency department visit facility fees for a visit of high to moderate severity 99284 $543.00 $0.00