Price Estimator
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Medicare
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2
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Laboratory & Pathology
Medicine & Surgery
Occupational Therapy
Patient Visits for Evaluation & Management
Physical Therapy
Radiology
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3
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Alanine Aminotransferase
HCPCS: 84460
Albumin Level
HCPCS: 82040
Ammonia Level
HCPCS: 82140
Amylase Level
HCPCS: 82150
Anaerobic Culture
HCPCS: 87075
Antibody ID - Red Cross
HCPCS: 86870
Antibody Screen GL
HCPCS: 86850
Antineutrophil Cytophasmic Antibodies (ANCA)
HCPCS: 86256
Antinuclear Antibody (ANA) Panel, Quantitative
HCPCS: 86225
Antinuclear Antibody (ANA) Screen
HCPCS: 86038
Aspartate Aminotransferase
HCPCS: 84450
Assay of Homocysteine
HCPCS: 83090
Assay pf Methylmalonic Acid, Serum
HCPCS: 83921
Automated urinalysis test
HCPCS: 81003
B-Type Natriuretic Peptide
HCPCS: 83880
Basic metabolic panel
HCPCS: 80048
Beta Human Chorionic Gonadotropin Quantitative
HCPCS: 84702
Bilirubin Total
HCPCS: 82247
Blood Culture
HCPCS: 87040
Blood test, clotting time
HCPCS: 85610
Blood test, thyroid stimulating hormone (TSH)
HCPCS: 84443
Blood typing serologic RH(D)
HCPCS: 86901
C-Reactive Protein
HCPCS: 86140
Calcium Ionized
HCPCS: 82330
Calcium Level Total
HCPCS: 82310
Canalith Repositioning Charge
HCPCS: 95992
Carbamazepine Level
HCPCS: 80156
Carcinoembryonic Antigen
HCPCS: 82378
Cerebrospinal Fluid Culture
HCPCS: 87205
Chlam/GC Nucleic Acid Screen
HCPCS: 87491
Cholesterol
HCPCS: 82465
Colonoscopy, diagnostic, including collection of specimen(s)
HCPCS: 45378
Colonoscopy, with biopsy, single or multiple
HCPCS: 45380
Colonoscopy, with removal of polyp(s) by snare technique
HCPCS: 45385
Complete blood cell count, with differential white blood cells, automated
HCPCS: 85025
Complete blood count, automated
HCPCS: 85027
Comprehensive Metabolic Panel
HCPCS: 80053
Cortisol AM
HCPCS: 82533
Covid-19, Influenza A/B, RSV Panel
HCPCS: 87631
Creatine Kinase
HCPCS: 82550
Creatinine
HCPCS: 82565
Crystal Exam, Synovial Fluid
HCPCS: 89060
CT - Abdomen and Pelvis w/ + w/o Contrast
HCPCS: 74178
CT - Abdomen and Pelvis w/ Contrast
HCPCS: 74177
CT - Abdomen and Pelvis w/o Contrast
HCPCS: 74176
CT - Abdomen w/ + w/o Contrast
HCPCS: 74170
CT - Abdomen w/ Contrast
HCPCS: 74160
CT - Abdomen w/o Contrast
HCPCS: 74150
CT - Angiography Abdomen
HCPCS: 74175
CT - Angiography Abdomen + Pelvis
HCPCS: 74174
CT - Angiography Chest w/ + w/o Contrast
HCPCS: 71275
CT - Chest/Thorax w/ + w/o Contrast
HCPCS: 71270
CT - Chest/Thorax w/ Contrast
HCPCS: 71260
CT - Chest/Thorax w/o contrast
HCPCS: 71250
CT - Head or Brain w/ + w/o Contrast
HCPCS: 70470
CT - Head or Brain w/o Contrast
HCPCS: 70450
CT - Lower extremity w/ Contrast
HCPCS: 73701
CT - Lower Extremity w/+w/o Contrast
HCPCS: 73702
CT - Lower extremity w/o Contrast
HCPCS: 73700
CT - Maxillofacial w/ + w/o Contrast
HCPCS: 70486
CT - Maxillofacial w/ + w/o Contrast
HCPCS: 70488
CT - Orbit, sella, or posterior fossa or outer, middle, or inner ear, w/o Contrast
HCPCS: 70480
CT - Orbit, sella, or posterior fossa or outer, middle, or inner ear; w/ contrast
HCPCS: 70481
CT - Pelvis w/ + w/o Contrast
HCPCS: 72194
CT - Pelvis w/ Contrast
HCPCS: 72193
CT - Pelvis w/o Contrast
HCPCS: 72192
CT - Soft Tissue Neck w/o Contrast
HCPCS: 70490
CT - Spine Cervical w/ + w/o Contrast
HCPCS: 72127
CT - Spine Cervical w/o Contrast
HCPCS: 72125
CT - Spine Lumbar w/ + w/o Contrast
HCPCS: 72133
CT - Spine Lumbar w/o Contrast
HCPCS: 72131
CT - Spine Thoracic w/ + w/o Contrast
HCPCS: 72129
CT - Spine Thoracic w/o Contrast
HCPCS: 72128
CT - Upper Extremity w/+w/o Contrast, bilateral, left or right
HCPCS: 73202
CT - Upper extremity w/o contrast
HCPCS: 73200
Culture ID
HCPCS: 87076
D-Dimer
HCPCS: 85379
Digoxin Level
HCPCS: 80162
Direct Antiglobulin Test
HCPCS: 86880
E-STIM Manual/15min Units
HCPCS: 97032
Electrical Stimulation Unattended Charge
HCPCS: G0283
Electrocardiogram (ECG), with at least 12 leads, without interpretation and report
HCPCS: 93005
Electrolyte Panel
HCPCS: 80051
Estradiol Level
HCPCS: 82670
Ethanol Level
HCPCS: 80320
Ferritin
HCPCS: 82728
Flu vaccination
HCPCS: G0008
Folate Level
HCPCS: 82746
Follicle Stimulating Hormone
HCPCS: 83001
Gait Training Units
HCPCS: 97116
Gamma Glutamyl Transferase
HCPCS: 82977
GI Panel - Bio Fire
HCPCS: 87507
Giardia
HCPCS: 87329
Glucose Level
HCPCS: 82947
Group A Strep Culture
HCPCS: 87081
Helicobacter IgG
HCPCS: 86677
Hemoglobin
HCPCS: 85018
Hemoglobin A1c
HCPCS: 83036
Hep B Surface Antibody
HCPCS: 86706
Hepatitis B Surface Antigen
HCPCS: 87340
Hepatitis C Total Ab
HCPCS: 86803
Hepatitis Panel RML
HCPCS: 80074
Hernia repair, femoral/inguinal/lumbar, age 5 years or older; reducible
HCPCS: 49505
Hernia repair, incisional/ventral, incarcerated or strangulated
HCPCS: 49561
Hernia repair, incisional/ventral; reducible
HCPCS: 49560
Herpes Simplex 1 or 2 AB
HCPCS: 87529
High Complex Units
HCPCS: 97167
High Complex Units
HCPCS: 97163
HIV Screen
HCPCS: 86703
Immunoassay for tumor antigen
HCPCS: 86301
Immunoelectrophoresis Random, Urine
HCPCS: 86335
Immunoelectrophoresis, Serum
HCPCS: 84165
Immunoglobulins, Quant Serum
HCPCS: 82784
Influenza A and B MOL
HCPCS: 87502
Insertion of non-indwelling bladder catheter
HCPCS: 51701
Insertion of temporary indwelling bladder catheter
HCPCS: 51702
Iontophoresis Charges
HCPCS: 97033
Iron Level
HCPCS: 83540
Kidney function panel test
HCPCS: 80069
Lactate Dehydrogenase
HCPCS: 83615
Lactic Acid
HCPCS: 83605
Lamotrigine
HCPCS: 80175
LDL Direct
HCPCS: 83721
Levetiracetam
HCPCS: 80177
Lipase Level
HCPCS: 83690
Lipid Panel Screen
HCPCS: 80061
Liver function blood test panel
HCPCS: 80076
Low Complex Units
HCPCS: 97165
Low Complex Units
HCPCS: 97161
Luteinizing Hormone
HCPCS: 83002
Magnesium Level
HCPCS: 83735
Manual Differential
HCPCS: 85007
Manual Therapy Charge Units
HCPCS: 97140
Manual urinalysis test with examination using microscope
HCPCS: 81001
Measles, IgG
HCPCS: 86765
Mechanical Traction Provided Units
HCPCS: 97012
Microalbumin Level Urine
HCPCS: 82043
Microalbumin/Creatinine Ratio, Urine
HCPCS: 82570
Moderate Complex Units
HCPCS: 97166
Moderate Complex Units
HCPCS: 97162
Morphine Confirmation
HCPCS: 80363
Mumps Ab, IgG/IgM
HCPCS: 86735
Neuromuscular Reeducation Units
HCPCS: 97112
Osmolality, Serum
HCPCS: 83930
Osmolality, Urine
HCPCS: 83935
Ova and Parasite Exam
HCPCS: 87209
Phenytoin Level
HCPCS: 80185
Phosphorus Level
HCPCS: 84100
Physical therapy, therapeutic exercise
HCPCS: 97110
Potassium Level
HCPCS: 84132
Prealbumin Level
HCPCS: 84134
Progesterone Level
HCPCS: 84144
Prolactin Level
HCPCS: 84146
Prostate Specific Antigen Screen
HCPCS: G0103
Protein 24 Hour Urine
HCPCS: 84156
Protein electrophoresis, Urine Random
HCPCS: 84166
Protein Total
HCPCS: 84155
PSA (Prostate Specific Antigen)
HCPCS: 84154
Rapid Clostridium Difficile Toxin A/B with QC
HCPCS: 87493
Rapid Mono Screen with QC
HCPCS: 86308
Rapid Occult Blood Diagnostic Stool
HCPCS: 82274
Rapid Occult Blood Screen Stool
HCPCS: 82270
Rapid Pregnancy Test Urine with QC
HCPCS: 81025
Rapid Pregnancy Test with QC
HCPCS: 84703
Rapid Respiratory Synctial Virus Screen with QC
HCPCS: 87807
Rapid Strep A Screen with QC
HCPCS: 87880
Rapid Urease Test with QC
HCPCS: 87077
Respiratory Virus Panel-PCR
HCPCS: 87633
Reticulocyte Count Automated
HCPCS: 85045
Rheumatoid Factor
HCPCS: 86431
Rubella IgG
HCPCS: 86762
Sedimentation Rate
HCPCS: 85652
Self Care, Home Management Charges
HCPCS: 97535
Serum Protein Electrophoresis(SPEP)
HCPCS: 86334
Shigella typing
HCPCS: 87070
Speech Behavral Qualit Analys Voice Units
HCPCS: 92524
Speech Eval of Speech Fluency Units
HCPCS: 92521
Speech Eval Speech Production Units
HCPCS: 92522
Speech Sound Language Comprehen Eval Units
HCPCS: 92523
Stool Culture with Shiga toxin
HCPCS: 87045
Swallow Evaluation Charge
HCPCS: 92610
Tacrolimus (Prograf)
HCPCS: 80197
Tease mount
HCPCS: 87086
Testosterone Level Total
HCPCS: 84403
THC GC/MS Confirmaiton
HCPCS: 80349
Therapeutic Activities Charge
HCPCS: 97530
Therapeutic Drug Assay
HCPCS: 80299
Thromboplastin time, partial (PTT); plasma or whole blood
HCPCS: 85730
Thyroglobulin Ab screen
HCPCS: 86376
Thyroglobulin, Tumor Marker
HCPCS: 84432
Thyroxine
HCPCS: 84436
Thyroxine Free
HCPCS: 84439
Treatment of Speech, Language, Voice Units
HCPCS: 92507
Treatment of Swallowing Dysfunction Unit
HCPCS: 92526
Triglycerides
HCPCS: 84478
Triiodothyronine Free
HCPCS: 84481
Triiodothyronine Reverse T3
HCPCS: 84482
Troponin-I
HCPCS: 84484
Type and Screen GL
HCPCS: 86900
UA Microscopic
HCPCS: 81015
Ultrasound Units
HCPCS: 97035
Uric Acid
HCPCS: 84550
Urine Drug Screen
HCPCS: 80305
Vaginitis Panel
HCPCS: 87660
Valproic Acid
HCPCS: 80164
Vanco Level
HCPCS: 80202
Venous Draw
HCPCS: 36415
Vitamin B12 Level
HCPCS: 82607
Vitamin D 25 Hydroxy Level
HCPCS: 82306
Vitamin D,1,25-Dihydroxy
HCPCS: 82652
X-Ray - Abdomen 1 View
HCPCS: 74018
X-Ray - Abdomen 2 Views
HCPCS: 74019
X-Ray - Abdomen Series w/ Chest 1 View
HCPCS: 74022
X-Ray - Abdomen, 3 or more views
HCPCS: 74021
X-Ray - Ankle, 2 Views, bilateral, left or right
HCPCS: 73600
X-Ray - Ankle, 3 or more views, bilateral, left or right
HCPCS: 73610
X-Ray - Calcaneus, bilateral, left or right
HCPCS: 73650
X-Ray - Chest 1 View
HCPCS: 71045
X-Ray - Chest 2 Views
HCPCS: 71046
X-Ray - Chest, 3 Views
HCPCS: 71047
X-Ray - Chest, 4 or more views
HCPCS: 71048
X-Ray - Clavicle Complete, bilateral, right or left
HCPCS: 73000
X-Ray - Clavicle Complete, bilateral, right or left
HCPCS: 73000
X-Ray - Elbow, 2 views, bilateral, left or right
HCPCS: 73070
X-Ray - Examination from nose to rectum for foreign body, single view, child
HCPCS: 76010
X-Ray - Facial Bones less than 3 Views
HCPCS: 70140
X-Ray - Femur, Min 2 Views, left or right
HCPCS: 73552
X-Ray - Finger(s) 2 views
HCPCS: 73140
X-Ray - Foot, 2 Views, bilateral, left or right
HCPCS: 73620
X-Ray - Foot, 3 or more views, bilateral, left or right
HCPCS: 73630
X-Ray - Forearm, 2 Views, bilateral, left or right
HCPCS: 73090
X-Ray - Hand 3 or more views, bilateral, left, or right
HCPCS: 73130
X-Ray - Hand, 2 Views, bilateral, left or right
HCPCS: 73120
X-Ray - Hip w/pelvis, 1 View, left or right
HCPCS: 73501
X-Ray - Hip w/pelvis, 2-3 View,left or right
HCPCS: 73502
X-Ray - Hip w/pelvis, 4 or more views
HCPCS: 73503
X-Ray - Hips, bilateral, w/ Pelvis 2 Views
HCPCS: 73521
X-Ray - Hips, bilateral, w/ Pelvis 3-4 Views
HCPCS: 73522
X-Ray - Humerus, 2 or mor views, bilateral, left or right
HCPCS: 73060
X-Ray - Knee 1 or 2 Views, bilateral, left or right
HCPCS: 73560
X-Ray - Knee, 3 Views, bilateral, left or right
HCPCS: 73562
X-Ray - Lower Extremity Infant, bilateral, left or right
HCPCS: 73592
X-Ray - Mandible Partial Less Than 4 Views
HCPCS: 70100
X-Ray - Nasal Bones, minimum 3 views
HCPCS: 70160
X-Ray - Neck, Soft Tissue
HCPCS: 70360
X-Ray - Orbits Complete Left or Right
HCPCS: 70200
X-Ray - Pelvis 1 or 2 Views
HCPCS: 72170
X-Ray - Pelvis Complete, minimum 3 Views
HCPCS: 72190
X-Ray - Ribs, 3 Views, Bilateral
HCPCS: 71110
X-Ray - Ribs, bilateral, w/ posteroanterior chest, minimum of 4 views
HCPCS: 71111
X-Ray - Ribs, unilateral, 2 views
HCPCS: 71100
X-Ray - Ribs, unilateral, w/ posteroanterior chest, minimum of 3 views
HCPCS: 71101
X-Ray - Sacrum/Coccyx Minimum 2 Views
HCPCS: 72220
X-Ray - Scapula Complete, left or right
HCPCS: 73010
X-Ray - Shoulder 1 View, bilateral, left or right
HCPCS: 73020
X-Ray - Shoulder 2 or more views, bilateral, left or right
HCPCS: 73030
X-Ray - Sinuses Paranasal Complete
HCPCS: 70220
X-Ray - Sinuses Paranasal, less than 3 Views
HCPCS: 70210
X-Ray - Skull Complete
HCPCS: 70260
X-Ray - Skull, less than 4 Views
HCPCS: 70250
X-Ray - Spine Cervical 2 or 3 Views
HCPCS: 72040
X-Ray - Spine Cervical 4 or 5 Views
HCPCS: 72050
X-Ray - Spine Entire 1 View
HCPCS: 72081
X-Ray - Spine Entire 2-3 Views
HCPCS: 72082
X-Ray - Spine Entire 4-5 Views
HCPCS: 72083
X-Ray - Spine Entire Min 6 Views
HCPCS: 72084
X-Ray - Spine Lumbosacral 2 or 3 Views
HCPCS: 72100
X-Ray - Spine Single View Specify Level
HCPCS: 72020
X-Ray - Spine Thoracic 2 Views
HCPCS: 72070
X-Ray - Spine, Lumbosacral, minimum 4 Views
HCPCS: 72110
X-Ray - Sternum, minimum 2 Views
HCPCS: 71120
X-Ray - Sternum, w/ sternoclavicular joints, minimum of 3 views
HCPCS: 71130
X-Ray - Tibia/Fibula, 2 views, left or right
HCPCS: 73590
X-Ray - Toe(s)
HCPCS: 73660
X-Ray - Urography, intravenous, w/ or w/o KUB
HCPCS: 74400
X-Ray - Wrist, 2 Views, bilateral, left or right
HCPCS: 73100
X-Ray - Wrist, 3 or more views, bilateral, left or right
HCPCS: 73110
X-Ray - Zygomatic Arches, less than 3 views
HCPCS: 70150
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus
HCPCS: 76805
PROCEDURE UNAVAILABLE
Biopsy of prostate gland
HCPCS: 55700
PROCEDURE UNAVAILABLE
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope
HCPCS: 43239
PROCEDURE UNAVAILABLE
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities
DRG: 216
PROCEDURE UNAVAILABLE
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC)
DRG: 473
PROCEDURE UNAVAILABLE
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope
HCPCS: 43235
PROCEDURE UNAVAILABLE
Electrocardiogram, routine, with interpretation and report
HCPCS: 93000
PROCEDURE UNAVAILABLE
Family psychotherapy, not including patient, 50 min
HCPCS: 90846
PROCEDURE UNAVAILABLE
Group psychotherapy
HCPCS: 90853
PROCEDURE UNAVAILABLE
Initial new patient preventive medicine evaluation (18-39 years)
HCPCS: 99385
PROCEDURE UNAVAILABLE
Initial new patient preventive medicine evaluation (40-64 years)
HCPCS: 99386
PROCEDURE UNAVAILABLE
Injection of substance into spinal canal of lower back or sacrum using imaging guidance
HCPCS: 62323
PROCEDURE UNAVAILABLE
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance
HCPCS: 64483
PROCEDURE UNAVAILABLE
Insertion of catheter into left heart for diagnosis
HCPCS: 93452
PROCEDURE UNAVAILABLE
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC)
DRG: 470
PROCEDURE UNAVAILABLE
Mammography of both breasts
HCPCS: 77066
PROCEDURE UNAVAILABLE
Mammography of one breast
HCPCS: 77065
PROCEDURE UNAVAILABLE
Mammography, screening, bilateral
HCPCS: 77067
PROCEDURE UNAVAILABLE
MRI scan of brain before and after contrast
HCPCS: 70553
PROCEDURE UNAVAILABLE
MRI scan of leg joint
HCPCS: 73721
PROCEDURE UNAVAILABLE
MRI scan of lower spinal canal
HCPCS: 72148
PROCEDURE UNAVAILABLE
New patient office of other outpatient visit, typically 45 min
HCPCS: 99204
PROCEDURE UNAVAILABLE
New patient office of other outpatient visit, typically 60 min
HCPCS: 99205
PROCEDURE UNAVAILABLE
New patient office or other outpatient visit, typically 30 min
HCPCS: 99203
PROCEDURE UNAVAILABLE
Obstetric blood test panel
HCPCS: 80055
PROCEDURE UNAVAILABLE
Patient office consultation, typically 40 min
HCPCS: 99243
PROCEDURE UNAVAILABLE
Patient office consultation, typically 60 min
HCPCS: 99244
PROCEDURE UNAVAILABLE
Psychotherapy, 30 min
HCPCS: 90832
PROCEDURE UNAVAILABLE
Psychotherapy, 45 min
HCPCS: 90834
PROCEDURE UNAVAILABLE
Psychotherapy, 60 min
HCPCS: 90837
PROCEDURE UNAVAILABLE
Removal of 1 or more breast growth, open procedure
HCPCS: 19120
PROCEDURE UNAVAILABLE
Removal of cataract with insertion of lens
HCPCS: 66984
PROCEDURE UNAVAILABLE
Removal of gallbladder using an endoscope
HCPCS: 47562
PROCEDURE UNAVAILABLE
Removal of one knee cartilage using an endoscope
HCPCS: 29881
PROCEDURE UNAVAILABLE
Removal of recurring cataract in lens capsule using laser
HCPCS: 66821
PROCEDURE UNAVAILABLE
Removal of tonsils and adenoid glands patient younger than age 12
HCPCS: 42820
PROCEDURE UNAVAILABLE
Routine obstetric care for cesarean delivery, including pre-and post-delivery care
HCPCS: 59510
PROCEDURE UNAVAILABLE
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care
HCPCS: 59610
PROCEDURE UNAVAILABLE
Routine obstetric care for vaginal delivery, including pre-and post-delivery care
HCPCS: 59400
PROCEDURE UNAVAILABLE
Shaving of shoulder bone using an endoscope
HCPCS: 29826
PROCEDURE UNAVAILABLE
Sleep study
HCPCS: 95810
PROCEDURE UNAVAILABLE
Spinal fusion except cervical without major comorbid conditions or complications (MCC)
DRG: 460
PROCEDURE UNAVAILABLE
Surgical removal of prostate and surrounding lymph nodes using an endoscope
HCPCS: 55866
PROCEDURE UNAVAILABLE
Ultrasound examination of lower large bowel using an endoscope
HCPCS: 45391
PROCEDURE UNAVAILABLE
Ultrasound of abdomen
HCPCS: 76700
PROCEDURE UNAVAILABLE
Ultrasound pelvis through vagina
HCPCS: 76830
PROCEDURE UNAVAILABLE
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)
DRG: 743
PROCEDURE UNAVAILABLE
Summary
Mercy Hospital
218 E Pack St
Moundridge, KS 67107
TIN: 48-0663711
NPI: 1083628911
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To schedule an appointment, please call our office at (620) 345-6391
If you are interested in financial assistance or payment options please visit https://www.mercyh.org/financial-assistance. You can also call our office at (620) 345-6391 or email info@mercyh.org.
This is just a good faith estimate and not a guarantee of final billed charges. This estimate is based on Mercy Hospital’s set charges and contracts Mercy Hospital has in place with insurance coverage providers. Secondary insurance payors are not taken into consideration in this quote. This estimate is subject to change. If you have secondary insurance coverage, any balance showing as patient responsibility will be sent to this payor for processing before the bill is sent to the patient. This estimate may vary based on patient health condition, unknown circumstances or complications, final diagnosis and recommended treatment ordered by your physician. Patients with insurance are encouraged to contact their insurance plan for the most accurate information regarding benefits, deductible and co-payment amounts. Professional fees for physicians, including radiologist and pathologist may not be included in this estimate.
This good faith estimate is not a contract.
If this estimate is $400 less then the bill you received for your services, you have the right to intiate a patient-provider dispute resolution process. You can find more information by following this link. https://www.cms.gov/nosurprises/consumers