The tables below provide the historical average charge for the most commonly used laboratory and radiology
services at Mercy Medical Center. The actual charges for service received may be higher or lower than the figures
below. Please contact our Financial Counseling Office at (401)332-9273 for assistance or for a more current price
list.
The amounts below reflect hospital charges only. Physicians bill seperately for their services.
Estimated Charges for Common Laboratory Procedures as of July 1, 2012
Procedure
ANTIBODY SCREEN
BASIC METABOLIC PANEL
BLOOD GAS
BLOOD TYPING, ABO TYPE
BLOOD TYPING, RH TYPE
COLLECT VENOUS BLOOD VENIPUNCTURE
COMPLETE (CBC) WITH AUTOMATED DIFFERENTIAL
COMPLETE (CBC) WITHOUT DIFFERENTIAL
COMPREHENSIVE METABOLIC PANEL
CREATINE KINASE (CPK)
HCG QUAL PREGNANCY TEST
HEPATIC PANEL
MAGNESIUM
MB FRACTION ONLY
MICROSCOPIC URINALYSIS
PHOSPHORUS
PROTHROMBIN TIME (PT)
THROMBOPLASTIN TIME, PARTIAL (PTT)
TROPONIN
URINALYSIS AUTO WITHOOUT SCOPE
CPT
88305
86901
86920
86900
84100
80048
80061
80053
86850
82550
83735
81015
85027
82553
85025
80076
85730
85610
84484
86920
Estimated
Charge
$138.20
$9.22
$18.42
$9.22
$4.60
$25.33
$43.76
$34.55
$27.64
$13.82
$13.82
$11.52
$18.42
$34.55
$23.03
$25.33
$18.42
$18.42
$57.58
$18.42
Estimated Charges for Common Radiology Procedures as of July 1, 2012
Procedure
BREAST ULTRASOUND LEFT
COMPUTED TOMOGRAPHY, ABDOMEN & PELVIS WITH CONTRAST
COMPUTED TOMOGRAPHY, ABDOMEN WITH CONTRAST
COMPUTED TOMOGRAPHY, CHEST,THORAX WITH CONTRAST
COMPUTED TOMOGRAPHY, HEAD SCAN WITHOUT CONTRAST
COMPUTED TOMOGRAPHY, PELVIC/SACRUM WITH CONTRAST
ECHOCARDIOGRAPHY TRANSTHORACIC WITH DOPPLER & COLOR FLOW
EXTREMITY ARTERIAL STUDY, BILATERAL SEGMENT ARTERIAL
EXTREMITY VENOUS STUDY, UNILATERAL OR LIMITED VENOUS DUPLEX
FLUOROSCOPY, GREATER THAN 1 HOUR
MAMMOGRAM BILATERAL DIGITAL
MAMMOGRAM SCREENING DIGITAL
MAMMOGRAM UNILATERAL DIGITAL
PELVIC - TRANSVAGINAL ULTRASOUND
RADIOLOGIC EXAMINATION, ABDOMEN (1 VIEW)
RADIOLOGIC EXAMINATION, CHEST (1 VIEW)
RADIOLOGIC EXAMINATION, CHEST (2 VIEWS)
RADIOLOGIC EXAMINATION, FOOT MINIMUM 3 VIEWS
RADIOLOGIC EXAMINATION, HAND MIN 3 VIEWS
ULTRASOUND PELVIC NON OBSTETRIC
CPT
76645
74177
74160
71260
70450
72193
93306
93923
93971
76001
G0204
G0202
G0206
76830
74000
71010
71020
73630
73130
76856
Estimated Charges for Common Outpatient Surgical Procedures as of July 1, 2012
Primary CPT
Procedure
Procedure
ARTHRODESIS
28750
ARTHROSCOPY KNEE WITH MENISECTOMY
29881
BIOPSY LIVER
47000
BIOPSY ULTRASOUND GUIDED PROSTATE
55700
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT
51720
BREAST BIOPSY
19125
CHOLECYSTECTOMY LAPAROSCOPIC
47562
COLONOSCOPY
45378
COLONOSCOPY WITH BIOPSY
45380
CYSTOSCOPY
52000
DAVINCI SALPINGECTOMY OOPHERECTOMY
58661
ENDOSCOPY, UPPER GASTROINTESTINAL (EGD)
43242
EXTRA CORPORAL SHOCKWAVE LITHOTRIPSY
50590
HYSTEROSCOPY
58558
INSERTION PORTACATH
36561
LAPAROSCOPIC TOTAL ABDOMINAL HYSTERECTOMY
58571
LEEP PROCEDURE
57522
MASTECTOMY PARTIAL
19301
PELVISCOPY
58662
REPAIR HERNIA INGUINAL LAPAROSCOPIC
49650
Estimated
Charge
$366.12
$338.98
$237.62
$237.62
$143.37
$237.62
$1,022.95
$293.14
$402.61
$293.14
$512.09
$366.12
$366.12
$402.61
$110.69
$74.19
$110.69
$110.69
$110.69
$402.61
Estimated
Charge
$ 7,800
$ 2,900
$ 2,400
$ 2,600
$ 1,500
$ 6,100
$ 6,000
$ 1,600
$ 2,400
$ 1,800
$ 7,200
$ 3,220
$ 4,400
$ 2,600
$ 5,300
$ 9,400
$ 2,300
$ 6,300
$ 6,500
$ 8,300
The tables below provide the historical range of charges for the most commonly used inpatient and
outpatient services at Mercy Medical Center, and the average charge for the service. This table is updated
quarterly and is based on the patient charges actually incurred for these services during the last six months
and may be used by patients to estimate the charge for services that they may incur. The actual charges
for service received may be higher or lower than the figures below as they will vary depending on the
patient's condition and the level of care or other services that are required and provided to the patient.
Please contact our Financial Counseling Office at (401)332-9273 for assistance or for a more current price
The amounts below reflect hospital charges only. Each physician or physician group that provides service
to you will charge you seperately for their services. Please contact the physician groups directly for charge
Estimated Charges for Common Inpatient Medical/Surgical Procedures as of July 1, 2012
Federal
Average
Federal DRG Description
DRG
Charge
ESOPHOGITIS, GASTROENTEROLOGY & MISC
392
$7,200
CHEST PAIN
313
$5,800
CERVICAL SPINAL FUSION
473
$17,300
COMBINED ANTERIOR/POSTERIOR SPINAL FUSION
454
$38,400
LAPAROSCOPIC CHOLECYSTECTOMY
419
$10,365
MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY
470
$24,800
MAJOR SMALL & LARGE BOWEL PROCEDURES
330
$31,500
MASTECTOMY FOR MALIGNANCY
583
$19,800
OTHER SKIN, TISSUE & BREAST PROCEDURES
581
$15,900
PANCREAS, LIVER & SHUNT PROCEDURES
406
$32,200
REVISION OF HIP OR KNEE REPLACEMENT
467
$24,600
SPINAL FUSION EXCEPT CERVICAL
460
$32,800
THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES
627
$7,100
UTERINE/ADNEXA PROCEDURES WITHOUT COMPLICATIONS
743
$9,000
UTERINE/ADNEXA PROCEDURES WITH COMPLICATIONS
742
$13,000
VASCULAR PROCEDURES
253
$33,200
Estimated Charges for Common Inpatient Obstetric Procedures as of July 1, 2012
Federal
Average
Federal DRG Description
DRG
Charge
CESAREAN SECTION WITH COMPLICATION
765
$10,200
CESAREAN SECTION WITHOUT COMPLICATION
766
$8,400
FULL TERM NEONATE WITH MAJOR PROBLEMS
793
$9,300
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
794
$2,600
NORMAL NEWBORN
795
$2,100
OTHER ANTEPARTUM DIAGNOSIS WITH MEDICAL COMPLICATION
781
$7,300
OTHER ANTEPARTUM DIAGNOSIS WITHOUT MEDICAL COMPLICATION
782
$6,600
PREMATURITY WITHOUT MAJOR PROBLEMS
792
$5,600
VAGINAL DELIVERY WITH COMPLICATING DIAGNOSIS
774
$6,900
VAGINAL DELIVERY WITHOUT COMPLICATING DIAGNOSIS
775
$6,500