UnityPoint Health - Iowa Lutheran Hospital
1200 Pleasant St, Des Moines, IA · UnityPoint Health · · NPI 1356433049
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $33.57 | $41.96 | $5.80 – $15.02 | 11 |
| Ghs protein, misc fluid CPT 84160 | $33.57 | $41.96 | $3.37 – $12.34 | 11 |
| Ghs protoporphyrins fract CPT 84202 | $64.28 | $80.35 | $8.61 – $23.62 | 11 |
| Ghs pr without cont pulse ox CPT 94625 | $405.35 | $506.68 | $16.08 – $148.96 | 13 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $31.20 | $39.00 | $7.35 – $19.06 | 9 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $568.72 | $710.89 | $117.34 – $249.00 | 8 |
| Ghs quinidine CPT 80194 | $66.43 | $83.03 | $8.76 – $24.41 | 11 |
| Ghs refill of implantable pump CPT 95990 | $320.40 | $400.49 | $76.49 – $319.57 | 13 |
| Ghs removal intranasal foreign body CPT 30300 | $464.00 | $580.00 | $108.80 – $225.50 | 13 |
| Ghs removal pharyngeal foreign body CPT 42809 | $495.20 | $619.00 | $96.30 – $384.46 | 13 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $2,309.05 | $2,886.31 | $536.90 – $1,541.92 | 13 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $2,851.65 | $3,564.56 | $452.69 – $3,126.02 | 13 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $48.57 | $60.71 | $9.53 – $22.26 | 11 |
| Ghs reticulocyte count CPT 85044 | $33.57 | $41.96 | $2.59 – $12.34 | 11 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $38.58 | $48.22 | $8.35 – $19.48 | 11 |
| Ghs sedimentation rate CPT 85651 | $33.57 | $41.96 | $4.27 – $12.34 | 11 |
| Ghs semen analysis fert CPT 89320 | $56.44 | $70.54 | $12.31 – $20.74 | 11 |
| Ghs semen analysis, post-vas CPT 89300 | $56.44 | $70.54 | $9.84 – $20.74 | 11 |
| Ghs sensitivity (per antimicro) CPT 87184 | $38.58 | $48.22 | $4.49 – $14.18 | 11 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $1,071.76 | $1,339.70 | $83.07 – $393.87 | 13 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $1,125.84 | $1,407.29 | $111.95 – $413.74 | 13 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $1,071.76 | $1,339.70 | $102.42 – $393.87 | 13 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $1,125.84 | $1,407.29 | $134.92 – $413.74 | 13 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $615.66 | $769.57 | $65.56 – $226.25 | 13 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $586.10 | $732.62 | $64.60 – $215.39 | 13 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $615.66 | $769.57 | $82.66 – $226.25 | 13 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $1,071.76 | $1,339.70 | $127.33 – $393.87 | 13 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $432.00 | $540.00 | $152.67 – $407.17 | 11 |
| Ghs sleep study unattended CPT 95800 | $357.60 | $447.00 | $35.91 – $150.74 | 11 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,084.08 | $1,355.09 | $24.26 – $398.40 | 13 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $745.60 | $932.00 | $41.11 – $511.21 | 11 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $267.11 | $333.88 | $45.09 – $117.88 | 11 |
| Ghs sphenopalatine ganglion block CPT 64505 | $616.00 | $770.00 | $92.87 – $284.41 | 11 |
| Ghs spont nystagmus CPT 92541 | $70.40 | $88.00 | $2.82 – $124.19 | 11 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $240.80 | $301.00 | $63.64 – $152.90 | 11 |
| Ghs st - eval for alt comm CPT 92567 | $77.18 | $96.47 | $9.87 – $37.82 | 13 |
| Ghs strapping shoulder - 29240 CPT 29240 | $301.21 | $376.51 | $16.60 – $124.19 | 13 |
| Ghs st - re-eval for alt comm CPT 92597 | $434.44 | $543.05 | $67.93 – $176.46 | 11 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $139.99 | $174.98 | $14.83 – $51.44 | 13 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $674.92 | $843.65 | $122.71 – $329.97 | 13 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $725.55 | $906.93 | $170.10 – $589.75 | 13 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $831.44 | $1,039.29 | $126.41 – $384.93 | 13 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $800.00 | $1,000.00 | $282.25 – $1,427.15 | 11 |
| Ghs trypsin (fecal) CPT 84488 | $18.40 | $23.00 | $4.38 – $11.35 | 9 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $779.20 | $974.00 | $142.13 – $560.20 | 13 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $1,491.20 | $1,864.00 | $214.36 – $571.87 | 11 |
| Ghs urine, hydroxproline total CPT 83505 | $61.60 | $77.00 | $14.58 – $37.81 | 9 |
| Ghs urine, porphyrins quant CPT 84120 | $64.28 | $80.35 | $8.83 – $23.62 | 11 |
| Ghs vaginal delivery only CPT 59409 | $4,192.53 | $5,240.66 | $691.99 – $3,063.32 | 13 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $2,096.88 | $2,621.09 | $505.13 – $1,134.93 | 13 |
| Ghs windowing of cast CPT 29730 | $152.00 | $190.00 | $39.77 – $152.03 | 11 |
| Giardia ag if CPT 87269 | $38.58 | $48.22 | $8.17 – $19.06 | 11 |
| Giardia lamblia antibody CPT 86674 | $48.57 | $60.71 | $8.83 – $22.90 | 11 |
| Gi endoscopic ultrasound CPT 76975 | $415.20 | $519.00 | $37.28 – $232.88 | 11 |
| Gi inhouse confirmation CPT 87045 | $38.58 | $48.22 | $5.66 – $14.70 | 11 |
| Gingivoplasty each quadrant CPT 41872 | $1,095.20 | $1,369.00 | $276.19 – $3,124.54 | 11 |
| Gi protein loss CPT 78282 | $700.00 | $875.00 | $14.21 – $387.14 | 11 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,459.56 | $3,074.45 | $102.88 – $903.89 | 13 |
| Gi trc img intral colon i&r CPT 91113 | $2,124.80 | $2,656.00 | $110.88 – $1,178.48 | 13 |
| Gi trc img intral esophagus CPT 91111 | $1,844.80 | $2,306.00 | $41.37 – $903.29 | 11 |
| Gi wireless capsule measure CPT 91112 | $3,660.00 | $4,575.00 | $96.43 – $903.29 | 11 |
| Gjb2 gene full sequence CPT 81252 | $202.40 | $253.00 | $41.87 – $141.59 | 11 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $36.91 – $86.13 | 9 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $21.00 – $48.99 | 9 |
| Glassia injection HCPCS J0257 | $7.20 | $9.00 | $5.39 – $6.96 | 9 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | $115.20 | $144.00 | $23.31 – $151.01 | 9 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | $88.00 | $110.00 | $36.95 – $98.80 | 9 |
| Glaucoma surgery CPT 66150 | $4,344.00 | $5,430.00 | $785.97 – $3,875.83 | 11 |
| Glaucoma surgery CPT 66155 | $4,340.80 | $5,426.00 | $785.35 – $3,875.83 | 11 |
| Glaucoma surgery CPT 66160 | $4,896.00 | $6,120.00 | $883.50 – $2,379.17 | 11 |
| Glaucoma surgery CPT 66170 | $5,425.60 | $6,782.00 | $981.62 – $2,639.24 | 11 |
| Glove finger flexion right lg xl HCPCS L3912 | $259.20 | $324.00 | $64.53 – $164.22 | 9 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $344.56 | $430.70 | $87.86 – $205.58 | 11 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $474.32 | $592.90 | $18.86 – $152.13 | 11 |
| Glucagon plasma - sendout CPT 82943 | $55.00 | $68.75 | $8.57 – $22.24 | 11 |
| Glucagon tolerance panel CPT 80422 | $116.00 | $145.00 | $27.64 – $71.67 | 9 |
| Glucagon tolerance panel CPT 80424 | $127.20 | $159.00 | $30.30 – $78.55 | 9 |
| Glucagon tolerance test CPT 82946 | $36.00 | $45.00 | $10.66 – $24.89 | 9 |
| Glucose 1 hr post dose CPT 82950 | $33.57 | $41.96 | $4.75 – $12.34 | 11 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $33.57 | $41.96 | $3.63 – $12.34 | 11 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $33.57 | $41.96 | $3.28 – $12.34 | 11 |
| Glucose blood quantitative CPT 82947 | $33.57 | $41.96 | $3.93 – $12.34 | 11 |
| Glucose body fluid CPT 82945 | $33.57 | $41.96 | $3.93 – $12.34 | 11 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $116.00 | $145.00 | $56.55 – $150.80 | 11 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $64.28 | $80.35 | $12.87 – $23.62 | 11 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $33.57 | $41.96 | $3.92 – $12.34 | 11 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $37.40 | $46.75 | $0.05 – $0.51 | 11 |
| Gold sodium thiomaleate inj HCPCS J1600 | $27.20 | $34.00 | $16.80 – $34.82 | 4 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $64.33 | $80.41 | $10.77 – $23.64 | 11 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $55.00 | $68.75 | $11.15 – $28.92 | 11 |
| Gonadotropin hormone panel CPT 80426 | $372.80 | $466.00 | $89.05 – $230.88 | 9 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $55.00 | $68.75 | $11.11 – $28.80 | 11 |
| Gonioscopy CPT 92020 | $58.40 | $73.00 | $18.61 – $124.19 | 11 |
| Goniotomy CPT 65820 | $3,884.80 | $4,856.00 | $732.53 – $3,875.83 | 11 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $667.20 | $834.00 | $443.67 – $791.71 | 9 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $194.72 | $243.40 | $30.36 – $71.56 | 8 |
| Graft axiofill 1000mg HCPCS J3590 | $927.14 | $1,158.92 | $0.94 – $2.25 | 5 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $410.80 – $1,902.26 | 5 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $895.72 | $1,119.64 | $40.80 – $198.49 | 8 |
| Graft hand or finger tendon CPT 26416 | $2,196.80 | $2,746.00 | $820.47 – $3,126.02 | 11 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.