MercyOne Elkader Medical Center
901 Davidson St. NW, Elkader, IA · MercyOne · · NPI 1184645434
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 |
|---|---|---|---|---|
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $286.00 | $286.00 | $32.15 – $298.93 | 568 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $146.25 | $225.00 | $115.81 – $235.17 | 42 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $252.00 | $252.00 | $32.15 – $252.00 | 568 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $251.00 | $251.00 | $32.15 – $250.85 | 568 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $470.00 | $276.00 | $32.15 – $274.89 | 568 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $323.00 | $323.00 | $42.50 – $324.01 | 568 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $7,377.95 | $7,377.95 | $1,112.25 – $7,711.43 | 113 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,591.20 | $2,448.00 | $1,259.99 – $2,558.65 | 42 |
| Abdominal MRI (with and without contrast) CPT 74183 | $3,478.15 | $5,351.00 | $2,754.16 – $5,592.87 | 42 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,333.80 | $2,052.00 | $1,056.16 – $2,144.75 | 42 |
| Abdominal Ultrasound (complete) CPT 76700 | $692.90 | $1,066.00 | $548.67 – $1,114.18 | 42 |
| Abdominal Ultrasound (limited) CPT 76705 | $556.40 | $856.00 | $440.58 – $894.69 | 42 |
| Abdominal X-ray (2 views) CPT 74019 | $250.90 | $386.00 | $198.67 – $403.45 | 42 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | $327.60 | $504.00 | $259.41 – $526.78 | 42 |
| Abdominal X-ray (single view) CPT 74018 | $163.15 | $251.00 | $129.19 – $262.35 | 42 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $1,196.00 | $1,840.00 | $947.05 – $1,923.17 | 42 |
| Acetaminophen 120 mg rectal suppository HCPCS A9270 | $9,149.29 | $2,532.65 | $0.51 – $2.46 | 113 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $55.20 | $55.20 | $17.23 – $57.70 | 113 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $121.20 | $121.20 | $22.20 – $126.68 | 113 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $424.00 | $424.00 | $119.30 – $420.17 | 779 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $360.00 | $386.00 | $47.03 – $347.01 | 779 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | $52.00 | $52.00 | $5.64 – $43.94 | 767 |
| Acute hepatitis panel CPT 80074 | $316.55 | $487.00 | $250.66 – $509.01 | 42 |
| Acyclovir 400 mg tablet HCPCS J8499 | $1.00 | $1.00 | $0.51 – $1.05 | 42 |
| Adapter b 8 channel 10cm HCPCS C1883 | $19,860.90 | $30,555.23 | $0.01 – $0.01 | 42 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $695.70 | $695.70 | $3.86 – $7.84 | 42 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $78.60 | $78.60 | $0.22 – $1.05 | 113 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $543.40 | $836.00 | $430.29 – $873.79 | 42 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $492.05 | $757.00 | $389.63 – $791.22 | 42 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $271.05 | $417.00 | $214.63 – $435.85 | 42 |
| Administration immunization each additional component CPT 90461 | $27.95 | $43.00 | $10.13 – $20.57 | 42 |
| Administration immunization each additional vaccine CPT 90472 | $65.00 | $100.00 | $4.32 – $35.33 | 780 |
| Administration immunization first component each vaccine CPT 90460 | $42.25 | $65.00 | $10.13 – $20.57 | 42 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $46.80 | $72.00 | $10.13 – $20.57 | 42 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $27.95 | $43.00 | $10.13 – $20.57 | 42 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $39.00 | $60.00 | $10.13 – $20.57 | 42 |
| Administration vaccine hepatitis b HCPCS G0010 | $57.20 | $88.00 | $10.13 – $20.57 | 42 |
| Administration vaccine influenza virus HCPCS G0008 | $78.00 | $88.00 | $5.09 – $39.00 | 780 |
| Administration vaccine pneumococcal HCPCS G0009 | $78.00 | $88.00 | $5.09 – $39.00 | 780 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $27.95 | $43.00 | $10.13 – $20.57 | 42 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $19,916.25 | $19,916.25 | $4,580.00 – $13,010.34 | 113 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $18,756.30 | $18,756.30 | $8,059.10 – $19,604.08 | 113 |
| Albumin body fluid quantitative each specimen CPT 82042 | $47.45 | $73.00 | $7.62 – $73.00 | 42 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $871.00 | $871.00 | $448.30 – $910.37 | 42 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $332.50 | $332.50 | $111.95 – $227.33 | 42 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $57.20 | $88.00 | $45.29 – $91.98 | 42 |
| Albumin serum plasma or whole blood CPT 82040 | $1,330.00 | $89.00 | $9.09 – $93.02 | 42 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $94.90 | $146.00 | $75.15 – $152.60 | 42 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $89,232.75 | $89,232.75 | $29,288.40 – $93,266.07 | 113 |
| Alkaline phosphatase CPT 84075 | $473.00 | $63.00 | $9.09 – $65.85 | 42 |
| Allergen alpha lactalbumin ige CPT 86008 | $31.20 | $48.00 | $17.57 – $48.00 | 42 |
| Allergen egg white ige CPT 86003 | $28.60 | $44.00 | $22.65 – $45.99 | 42 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $43.26 | $66.55 | $34.25 – $69.56 | 42 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $424.66 | $653.33 | $119.32 – $242.30 | 42 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $3,961.09 | $6,093.98 | $58.57 – $118.94 | 42 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,663.49 | $5,636.14 | $19.10 – $38.78 | 42 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $159.49 | $245.37 | $14.85 – $30.15 | 42 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $2,097.63 | $3,227.12 | $32.40 – $65.80 | 42 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $238.13 | $366.35 | $102.95 – $209.05 | 42 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $5,609.82 | $8,630.50 | $397.73 – $807.68 | 42 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $232.74 | $358.06 | $177.78 – $361.02 | 42 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $815.54 | $1,254.67 | $309.90 – $629.31 | 42 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $2,450.00 | $2,450.00 | $1,261.02 – $2,560.74 | 42 |
| Alpha-fetoprotein tumor marker CPT 82105 | $1,956.00 | $199.00 | $9.09 – $207.99 | 42 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $25,477.05 | $25,477.05 | $188.30 – $588.29 | 112 |
| Alt/sgpt CPT 84460 | $802.00 | $104.00 | $9.09 – $108.70 | 42 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $101.15 | $101.15 | $52.06 – $105.72 | 42 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $212.00 | $212.00 | $13.05 – $166.71 | 113 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $9.20 | $9.20 | $2.55 – $9.62 | 113 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $11,933.95 | $11,933.95 | $4,252.50 – $12,473.36 | 113 |
| Ammonia CPT 82140 | $154.70 | $238.00 | $14.42 – $248.76 | 42 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $8.75 | $8.75 | $4.50 – $34.12 | 113 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $562.35 | $562.35 | $289.44 – $587.77 | 42 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $38.85 | $38.85 | $0.98 – $6.17 | 113 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $14.55 | $14.55 | $2.98 – $6.64 | 113 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $512.85 | $789.00 | $406.10 – $824.66 | 42 |
| Amylase CPT 82150 | $71.50 | $110.00 | $6.48 – $114.97 | 42 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $154.05 | $237.00 | $121.98 – $247.71 | 42 |
| Analysis gene f2 20210g>a variant CPT 81240 | $110.50 | $170.00 | $87.50 – $177.68 | 42 |
| Analysis gene f5 leiden variant CPT 81241 | $379.60 | $584.00 | $300.58 – $610.40 | 42 |
| Anchor suture 3.5mm pushlock HCPCS C1741 | $2,155.00 | $3,315.38 | $866.70 – $1,760.00 | 42 |
| Ankle X-ray CPT 73610 | $407.55 | $627.00 | $215.14 – $436.89 | 42 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $356.20 | $548.00 | $187.87 – $381.50 | 42 |
| Annual Physical, Established Patient (age 18-39) CPT 99395 | $283.00 | $283.00 | $53.05 – $281.16 | 568 |
| Annual Physical, Established Patient (age 40-64) CPT 99396 | $301.00 | $301.00 | $42.50 – $299.97 | 568 |
| Annual Physical, New Patient (age 18-39) CPT 99385 | $313.00 | $313.00 | $58.24 – $314.61 | 568 |
| Annual Physical, New Patient (age 40-64) CPT 99386 | $363.00 | $363.00 | $66.40 – $379.41 | 568 |
| Antibody elution rbc reference CPT 86860 | $85.80 | $132.00 | $67.94 – $137.97 | 27 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $257.40 | $396.00 | $203.82 – $413.90 | 42 |
| Antibody id rbc panel CPT 86870 | $291.85 | $449.00 | $231.10 – $469.29 | 41 |
| Antibody screen rbc CPT 86850 | $85.80 | $132.00 | $9.77 – $137.97 | 42 |
| Anticoag mgmt pt warfarin CPT 93793 | $25.35 | $39.00 | $20.07 – $40.76 | 42 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | $5,144.60 | $5,144.60 | $894.00 – $2,791.15 | 113 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $147.55 | $227.00 | $116.84 – $237.26 | 42 |
| Antinuclear antibodies CPT 86038 | $105.95 | $163.00 | $83.90 – $170.37 | 42 |
| Antinuclear antibodies titer CPT 86039 | $85.80 | $132.00 | $67.94 – $137.97 | 42 |
| Antistreptolysin o screen CPT 86063 | $48.75 | $75.00 | $38.60 – $78.39 | 42 |
| Antithrombin iii activity CPT 85300 | $135.20 | $208.00 | $107.06 – $217.40 | 42 |
| Anti-thymocyte glob (equine)(1:1000) intradermal test dose HCPCS J7504 | $14,664.50 | $14,664.50 | $5,013.11 – $15,327.34 | 113 |
| Aortic Aneurysm Screening Ultrasound CPT 76706 | $393.90 | $606.00 | $311.91 – $633.39 | 42 |
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.