Mercy Hospital Ada Inc
Mercy Hospital Ada Inc in Ada, OK publishes cash prices for 58 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
430 N Monte Vista St Ada OK 74820 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Abd Pelvis With Contrast | $3,545.75 | $5,455.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Head/Brain WO Cont | $1,209.65 | $1,861.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Pelvis W Cont | $1,903.85 | $2,929.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 Mamm Diagnostic Bilat W Cad | $206.70 | $318.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 Mamm Diagnostic Unilat Rt W Cad | $148.20 | $228.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 Mamm Diagnostic Unilat Lt W Cad | $148.20 | $228.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye both sides CPT 73721 MRI Extr Lwr Jt WO Cont Bi | $2,568.15 | $3,951.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Extr Lwr Jt WO Cont Lt | $1,685.45 | $2,593.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 MRI Extr Lwr Jt WO Cont Rt | $1,685.45 | $2,593.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Extr Lwr Jt W/WO Cont Lt | $2,518.10 | $3,874.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 MRI Extr Lwr Jt W/WO Cont Rt | $2,518.10 | $3,874.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 MRI Brain WO Cont | $2,113.15 | $3,251.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Brain W/WO Cont | $3,630.90 | $5,586.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Lumbar Spine WO Cont | $2,639.65 | $4,061.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US Preg Uter 14 Wks Or> | $344.50 | $530.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 Mamm Scrn Bilat Implant W Cad | $286.65 | $441.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 Mamm Scrn Bilateral W Cad | $286.65 | $441.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 Mamm Scrn Right W Cad | $191.10 | $294.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 Mamm Scrn Left W Cad | $191.10 | $294.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 Polysom Attended >3 Chn 6/> Yrs | $4,529.85 | $6,969.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 US Transvaginal Non OB | $709.80 | $1,092.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 US Abdomen Complete | $673.40 | $1,036.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 Xr Spine Lumbar Min 4 Views | $496.60 | $764.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic Metabolic Pnl Calcium Total | $18.85 | $29.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid Panel | $48.10 | $74.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 POC Lipid Panel | $119.60 | $184.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 Cbc W Auto Diff | $17.55 | $27.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 Cbc Automated WO Diff | $14.30 | $22.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive Metabolic Panel | $23.40 | $36.00 | 35% |
| Kidney function blood test panel CPT 80069 Renal Function Panel | $31.20 | $48.00 | 35% |
| Liver function blood test panel CPT 80076 Hepatic Function Panel | $22.10 | $34.00 | 35% |
| Obstetric blood test panel CPT 80055 Obstetric Panel | $323.70 | $498.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Psa Free | $65.65 | $101.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Total Diagnostic | $65.65 | $101.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa Ultrasensitive | $126.75 | $195.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt Partial Thromboplastin Time | $26.65 | $41.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Ptt Mixing | $79.95 | $123.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time | $14.30 | $22.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 POC Prothrombin Time | $47.45 | $73.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Prothrombin Time Mixing Test | $67.60 | $104.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Newborn | $11.05 | $17.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Tsh Thyroid Stimulating Hormone | $59.80 | $92.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis Automated W Micro | $11.05 | $17.00 | 35% |
| Urinalysis with microscope exam, manual CPT 81000 Urinalysis Non Automated W Micro | $16.90 | $26.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 Urinalysis Automated W/O Micro | $7.80 | $12.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Ph Automated | $61.10 | $94.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 Specific Gravity Urine Automated | $72.80 | $112.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 POC Urinalysis Automated W/O Micro | $72.80 | $112.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Ketones Automated | $72.80 | $112.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 Urine Ketones Nonautomated | $29.90 | $46.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis Non Automated WO Micro | $29.90 | $46.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 Urine Ph Nonautomated | $29.90 | $46.00 | 35% |
| Urinalysis without microscope exam, manual CPT 81002 POC Urinalysis Non-Auto | $29.90 | $46.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 GI Colo Biopsy Snare Pf | $3,227.65 | $4,965.61 | 35% |
| Colonoscopy with tissue sample CPT 45380 GI Colo Biopsy Cold Pf | $3,506.07 | $5,393.96 | 35% |
| Colonoscopy, diagnostic CPT 45378 GI Colonoscopy | $1,595.10 | $2,454.00 | 35% |
| Gallbladder removal, laparoscopic CPT 47562 Lap,Cholecystectomy Pf | $12,082.14 | $18,587.91 | 35% |
| Inguinal (groin) hernia repair, age 5 or older CPT 49505 Rx Ing Hernia,5+Y/O,Reducibl Pf | $10,777.96 | $16,581.48 | 35% |
| Knee arthroscopy with meniscus trim CPT 29881 Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg | $8,710.88 | $13,401.35 | 35% |
| Left heart catheterization, diagnostic one side CPT 93452 Lt Heart Cath Including Inj Lt Ventriculography, S/I | $10,086.70 | $15,518.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 Inject Interlaminar Lumbar or Sacral W Imag | $2,694.90 | $4,146.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 Inj Dx/Tx Epid/Subaracr Lmbr/Sac WO Imag | $8,193.25 | $12,605.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Inj Transforminal Epi/Lumb/Sacral Sngl Level | $2,509.00 | $3,860.00 | 35% |
| Prostate biopsy CPT 55700 Bx Prostate Needle/Punch | $11,316.04 | $17,409.29 | 35% |
| Shoulder arthroscopy: shaving of the shoulder bone (add-on to another shoulder surgery) CPT 29826 Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls | $22,561.47 | $34,709.96 | 35% |
| Tonsil and adenoid removal, child under 12 CPT 42820 Tonsillectomy & Adenoidectomy <Age 12 | $5,168.01 | $7,950.78 | 35% |
| Upper endoscopy (EGD) with biopsy CPT 43239 GI Egd W/Biopsy Pf | $3,779.72 | $5,814.95 | 35% |
| Upper endoscopy (EGD), diagnostic CPT 43235 GI Upper Endoscopy Complex | $1,142.05 | $1,757.00 | 35% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 Cd Fam Ther W Patient 50 Min (Max Qty 2) | $316.55 | $487.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 Psych Fam Ther W Pt 50min (Max Qty 2) | $316.55 | $487.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 Psych Fam Ther WO Pt 50min (Max Qty 2) | $280.80 | $432.00 | 35% |
| Family therapy without the patient, 50 minutes CPT 90846 Cd Fam Ther WO Patient 50 Min (Max Qty 2) | $280.80 | $432.00 | 35% |
| Group psychotherapy session CPT 90853 Group Tx-Iop | $552.50 | $850.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 OP Visit Level III New Patient | $221.00 | $340.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 OP Visit Level III New Pt | $221.00 | $340.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 OP Visit Level IV New Pt | $293.15 | $451.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 OP Visit Level V New Pt | $351.65 | $541.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 OP Visit Level V New Patient | $518.05 | $797.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Ot Ther Exer 1 or > Area Ea 15m | $129.35 | $199.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Pt Ther Exer 1 or > Area Ea 15m | $129.35 | $199.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 Psych Ther 30 Min With Patient | $222.95 | $343.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 Straight CSF Grant Counseling 30 Minutes | $222.95 | $343.00 | 35% |
| Psychotherapy session, 30 minutes CPT 90832 Cd Ther 30 Min W Patient | $222.95 | $343.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 Cd Ther 45 Min W Patient | $270.40 | $416.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 Straight CSF Grant Counseling 45 Minutes | $270.40 | $416.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 Psych Ther 45 Min With Patient | $270.40 | $416.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 Psych Ther 60 Min With Patient | $306.80 | $472.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 Cd Ther 60 Min W Patient | $306.80 | $472.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 Straight CSF Grant Counseling 60 Minutes | $306.80 | $472.00 | 35% |
Source file: https://www.mercy.net/content/dam/mercy/en/web-assets/charge-files/462288155_mercy-hospital-ada_standardcharges.zip