UnityPoint Health - Trinity Regional Medical Center
802 Kenyon Road, Fort Dodge, IA · UnityPoint Health · · NPI 1487759858
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 |
|---|---|---|---|---|
| X-ray exam of middle ear CPT 70134 | $114.40 | $143.00 | $15.87 – $467.32 | 9 |
| X-ray exam of penis CPT 74445 | $606.40 | $758.00 | $46.12 – $110.87 | 9 |
| X-ray exam of perineum CPT 74775 | $588.00 | $735.00 | $27.29 – $206.02 | 9 |
| X-ray exam of salivary gland CPT 70380 | $82.40 | $103.00 | $7.42 – $75.04 | 9 |
| X-ray exam of tear duct CPT 70170 | $728.80 | $911.00 | $13.25 – $206.02 | 9 |
| X-ray exam of teeth CPT 70300 | $32.00 | $40.00 | $4.56 – $75.04 | 9 |
| X-ray exam of teeth CPT 70310 | $82.40 | $103.00 | $7.39 – $206.02 | 9 |
| X-ray exam si joints CPT 72200 | $225.08 | $281.35 | $7.71 – $239.15 | 11 |
| X-ray exam thorac spine4/>vw CPT 72074 | $361.41 | $451.76 | $10.89 – $384.00 | 11 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $147.16 | $183.95 | $8.04 – $156.36 | 11 |
| X-ray fallopian tube CPT 74742 | $264.00 | $330.00 | $26.67 – $60.35 | 7 |
| X-ray head for orthodontia CPT 70350 | $41.60 | $52.00 | $7.83 – $75.04 | 9 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $323.47 | $404.33 | $12.28 – $343.68 | 11 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $559.44 | $699.29 | $13.87 – $594.40 | 11 |
| X-ray joint survey 1 view CPT 77077 | $349.38 | $436.72 | $15.10 – $371.21 | 11 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $264.89 | $331.11 | $7.10 – $281.44 | 11 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $261.31 | $326.63 | $9.92 – $277.64 | 11 |
| X-ray male genital tract CPT 74440 | $182.40 | $228.00 | $16.57 – $206.02 | 9 |
| X-ray mandible ltd <4 views CPT 70100 | $80.80 | $101.00 | $8.04 – $84.33 | 11 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $28.00 – $34.03 | 3 |
| X-ray nose to rectum for foreign body child CPT 76010 | $200.42 | $250.52 | $8.04 – $212.94 | 11 |
| X-ray of mammary ducts CPT 77054 | $1,170.24 | $1,462.80 | $19.58 – $1,243.38 | 11 |
| X-ray optic foramina CPT 70190 | $159.69 | $199.61 | $9.89 – $169.67 | 11 |
| Xray place dist ext thor ao CPT 75959 | $4,111.20 | $5,139.00 | $0.01 – $337.94 | 7 |
| Xray place prox ext thor ao CPT 75958 | $3,684.00 | $4,605.00 | $0.01 – $390.00 | 7 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $625.87 | $782.33 | $22.73 – $664.98 | 11 |
| X-ray ribs 2 views left CPT 71100 | $271.88 | $339.85 | $9.92 – $288.87 | 11 |
| X-ray sella turcica CPT 70240 | $62.40 | $78.00 | $8.36 – $75.04 | 9 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $315.75 | $394.68 | $22.78 – $467.32 | 11 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $694.76 | $868.44 | $25.41 – $738.17 | 11 |
| X-ray small intestine follow-through study CPT 74248 | $543.73 | $679.66 | $30.62 – $577.71 | 9 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $270.08 | $337.60 | $9.63 – $286.96 | 11 |
| X-ray surgical specimen CPT 76098 | $187.55 | $234.43 | $13.87 – $467.32 | 11 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $155.04 | $193.80 | $11.51 – $164.73 | 11 |
| X-ray upper gi delay w/kub CPT 74241 | not published | not published | $63.00 – $63.00 | 2 |
| X-ray upper gi&small intest CPT 74245 | not published | not published | $83.00 – $83.00 | 2 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | $178.40 | $223.00 | $25.73 – $151.73 | 9 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $207.48 – $604.55 | 7 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | $253.60 | $317.00 | $62.97 – $169.62 | 7 |
| Xwrap 1 sq cm HCPCS Q4204 | not published | not published | $2,850.00 – $2,935.50 | 3 |
| Xylose absorption test blood &/or urine CPT 84620 | $64.28 | $80.35 | $7.75 – $68.30 | 9 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.42 – $1.68 | 7 |
| Yersinia antibody CPT 86793 | $33.60 | $42.00 | $7.91 – $20.52 | 7 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $56,824.55 – $110,513.94 | 7 |
| Zenith amniotic membrane psc HCPCS Q4253 | not published | not published | $71.50 – $687.19 | 5 |
| Ziconotide injection HCPCS J2278 | not published | not published | $9.66 – $11.75 | 7 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | not published | not published | $1.51 – $2.08 | 6 |
| Zidovudine, oral, 100 mg HCPCS S0104 | not published | not published | $1.51 – $3.12 | 6 |
| Zika virus dna/rna amp probe CPT 87662 | $103.20 | $129.00 | $30.79 – $79.84 | 9 |
| Zika virus igm antibody CPT 86794 | $48.57 | $60.71 | $10.11 – $51.60 | 9 |
| Zinc paste band w >=3"<5"/yd HCPCS A6456 | $4.00 | $5.00 | $0.88 – $2.22 | 7 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $92.05 | $115.06 | $5.18 – $38.25 | 8 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $7.09 – $10.31 | 7 |
| Zolbetuximab-clzb 100 mg intravenous solution HCPCS J1326 | not published | not published | $34.23 – $35.23 | 4 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $432.92 | $541.14 | $5.73 – $44.10 | 8 |
| Zoster vaccine-live inj CPT 90736 | $204.80 | $256.00 | $221.79 – $319.46 | 4 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $115.95 – $292.26 | 7 |
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.