Supplies, drugs & other prices at Mercy Hospital Fort Smith

Fort Smith, AR · every code in this section with a posted price and a Medicare benchmark.

93 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2d tee w or w/o fol w/con,in (C8925) $2,342.60 $3,604 3.1×
2d tte w or w/o fol w/con,co (C8923) $1,468.35 $2,259 1.9×
2d tte w or w/o fol w/con,fu (C8924) $1,122.55 $1,727 3.3×
Adm tocilizu covid-19 1st (M0249) $482.95 $743 1.1×
Adm tocilizu covid-19 2nd (M0250) $482.95 $743 1.1×
Admin hepatitis b vaccine (G0010) $9.75 $15 0.2×
Admin influenza virus vac (G0008) $11.05 $17 0.2×
Admin pneumococcal vaccine (G0009) $11.05 $17 0.2×
Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative Other Outpatient (0064U) $61.10 $94 2.0×
Catheterize for urine spec (P9612) $50.05 $77 5.4×
Chemo extend iv infus w/pump (G0498) $462.15 $711 1.4×
CYP1A2 (cytochrome P450 family 1, subfamily A, member 2) (eg, drug metabolism) gene analysis, common variants (ie, *1F,… (0031U) $503.10 $774 2.9×
Cyp2d6 gen com&slct rar vrnt (0070U) $672.75 $1,035 1.0×
Diab manage trn per indiv (G0108) $119.60 $184 2.1×
Diab manage trn ind/group (G0109) $64.35 $99 4.0×
Direct refer hospital observ (G0379) $352.30 $542 0.6×
Endovascular Venous Arterialization Tibl/Prnl Vn (0620T)
likely a partial charge, not the full procedure
$11,522.55 $17,727 0.3×
Esophagogastroduodenoscopy , flexible, transoral, with volume adjustment of intragastric bariatric balloon (0813T) $2,112.50 $3,250 2.4×
Extrnl counterpulse, per tx (G0166) $369.85 $569 2.9×
Fern test (Q0114) $52.98 $81.50 5.4×
Hbot, full body chamber, 30m (G0277) $564.20 $868 4.2×
Home sleep test/type 3 porta (G0399) $622.05 $957 3.0×
Ig paraprotein qual bld/ur (0077U) $218.40 $336 5.0×
Inj for sacroiliac jt anesth (G0260) $2,220.08 $3,415.50 3.2×
Insj/Rplcmt Icds W/Substernal Electrode (0571T) $45,598.80 $70,152 1.5×
Intrav inf, toci, first dose (M0237) $482.95 $743 1.1×
Intrav inf, toci, second dos (M0238) $482.95 $743 1.1×
Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) $272.35 $419 2.2×
Liver dis 10 assays w/nash (0003M) $843.05 $1,297 1.7×
Mra w/cont, abd (C8900) $1,254.50 $1,930 3.7×
Mra w/cont, chest (C8909) $1,537.90 $2,366 4.6×
Mra w/cont, lwr ext (C8912) $1,528.15 $2,351 4.5×
Mra w/cont, pelvis (C8918) $1,550.25 $2,385 4.6×
Mra w/o cont, abd (C8901) $1,014.65 $1,561 4.4×
Mra w/o cont, chest (C8910) $1,268.15 $1,951 5.5×
Mra w/o cont, lwr ext (C8913) $1,261.65 $1,941 5.5×
Mra w/o cont, pelvis (C8919) $1,288.30 $1,982 5.6×
Mra w/o fol w/cont, abd (C8902) $1,762.15 $2,711 5.2×
Mra w/o fol w/cont, chest (C8911) $1,710.80 $2,632 5.1×
Mra w/o fol w/cont, lwr ext (C8914) $1,210.30 $1,862 3.6×
Mra w/o fol w/cont, pelvis (C8920) $1,751.10 $2,694 5.2×
Mri w/cont, breast, bi (C8906) $1,977.95 $3,043 5.9×
Mri w/cont, breast, uni (C8903) $1,560.65 $2,401 9.2×
Mri w/o fol w/cont, breast, (C8908) $2,100.80 $3,232 6.2×
Mri w/o fol w/cont, brst, un (C8905) $1,739.40 $2,676 5.1×
Neuro csf detcj prion prtn quakg conf conv qual (0035U) $184.60 $284 0.3×
Oth resp proc, group (G0239) $104.65 $161 2.9×
Pathogen test for platelets (P9100) $60.45 $93 1.1×
Perc d-e cor revasc chro sin (C9607) $12,348.05 $18,997 0.7×
Perc d-e cor revasc t cabg s (C9604) $7,868.90 $12,106 0.7×
Perc d-e cor stent ather s (C9602) $10,372.05 $15,957 0.6×
Perc drug-el cor stent sing (C9600) $8,836.75 $13,595 0.8×
Percutaneous transcatheter thermal ablation of nerves innervating the pulmonary arteries, including right heart… (0793T) $12,711.40 $19,556 0.7×
Perq Sacral Augmt Bilat Inj (0201T) $6,988.80 $10,752 1.0×
Perq Tcat Ther Rx Dlvr Ntrac Rx Balo 1 Maj C Art (0913T) $12,950.60 $19,924 1.2×
Place device/marker, non pro (C9728) $890.50 $1,370 0.7×
Prgrmg dev eval ldls pm single car chamber ip (0826T) $113.10 $174 3.1×
Prgrmg dev eval ldls pm sys 2chmbr in person (0804T) $131.30 $202 3.6×
Psa screening (G0103) $68.90 $106 3.6×
Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) $615.55 $947 0.9×
Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device… (0863T) $2,930.85 $4,509 1.5×
Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device… (0862T) $2,930.85 $4,509 1.5×
Removal Pg Wcs Lv Pacing Both Components (0861T) $2,930.85 $4,509 0.8×
Revasc intra lithotrip-ather (C9766) $10,641.15 $16,371 0.6×
Revasc intra lithotrip-stent (C9765) $11,635.65 $17,901 0.7×
Revasc intravasc lithotripsy (C9764) $8,580 $13,200 0.8×
Revasc lith-sten-ath tib/per (C9775) $19,448 $29,920 1.1×
Revasc lithotr-ather tib/per (C9774) $14,221.35 $21,879 0.8×
Revasc lithotr-stent tib/per (C9773) $11,635.65 $17,901 0.7×
Revasc lithotrip tibi/perone (C9772) $10,951.20 $16,848 1.0×
Revasc lithotrip-stent-ather (C9767) $19,448 $29,920 1.1×
Scr c/v cyto,thinlayer,rescr (G0145) $70.85 $109 2.7×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $17,324.45 $26,653 0.9×
Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) $19,249.10 $29,614 1.0×
Tcat insj perm 2chmbr ldls pm r ventr pm compnt (0797T) $17,324.45 $26,653 0.9×
Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) $19,249.10 $29,614 1.0×
Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) $3,978 $6,120 1.3×
Tcat rmvl perm 2chmbr ldls pm r atr pm compnt (0799T) $1,929.85 $2,969 0.6×
Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt (0800T) $2,078.05 $3,197 0.7×
Tcat rmvl perm dual chamber ldls pm compl sys (0798T) $1,929.85 $2,969 0.6×
Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) $17,324.45 $26,653 0.9×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T)
likely a partial charge, not the full procedure
$2,078.05 $3,197 0.1×
Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T)
likely a partial charge, not the full procedure
$2,078.05 $3,197 0.1×
Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt (0803T)
likely a partial charge, not the full procedure
$2,078.05 $3,197 0.1×
Tomosynthesis, mammo (G0279) $63.70 $98 5.0×
Tpmt Nudt15 Gene Analysis Common Variants (0034U) $364 $560 0.8×
Trauma respons w/hosp criti (G0390) $3,296.15 $5,071 2.6×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $8,819.20 $13,568 0.8×
Trluml peripheral atherectomy iliac artery ea (0238T) $11,758.50 $18,090 0.7×
Tte w or w/o contr, cont ecg (C8930) $1,669.20 $2,568 2.2×
Tte w or wo fol wcon,doppler (C8929) $2,119.65 $3,261 2.8×
Unsched dialysis esrd pt hos (G0257) $1,316.90 $2,026 2.0×
Visit to determ ldct elig (G0296) $16.25 $25 0.2×