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 |
|---|---|---|---|---|
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $341.60 | $427.00 | $65.56 – $267.28 | 11 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $315.20 | $394.00 | $64.60 – $265.63 | 11 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $412.80 | $516.00 | $82.66 – $267.28 | 11 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $784.32 | $980.40 | $127.33 – $833.34 | 11 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $432.00 | $540.00 | $152.67 – $407.17 | 9 |
| Ghs sleep study unattended CPT 95800 | $357.60 | $447.00 | $35.91 – $133.35 | 9 |
| Ghs somatosensory testing lower extremit CPT 95926 | $302.40 | $378.00 | $24.26 – $265.41 | 9 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $745.60 | $932.00 | $41.11 – $452.24 | 9 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $265.43 | $331.78 | $45.09 – $282.01 | 9 |
| Ghs sphenopalatine ganglion block CPT 64505 | $931.08 | $1,163.85 | $92.87 – $989.27 | 11 |
| Ghs spont nystagmus CPT 92541 | $70.40 | $88.00 | $2.82 – $109.87 | 9 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $265.43 | $331.78 | $95.77 – $282.01 | 9 |
| Ghs st - eval for alt comm CPT 92567 | $35.20 | $44.00 | $9.87 – $33.46 | 9 |
| Ghs strapping shoulder - 29240 CPT 29240 | $180.16 | $225.19 | $16.60 – $191.41 | 11 |
| Ghs st - re-eval for alt comm CPT 92597 | $328.26 | $410.32 | $67.93 – $348.77 | 9 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $33.60 | $42.00 | $14.83 – $39.32 | 9 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $342.40 | $428.00 | $122.71 – $333.60 | 9 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $720.80 | $901.00 | $170.10 – $521.72 | 11 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $438.91 | $548.63 | $126.41 – $466.34 | 11 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $800.00 | $1,000.00 | $282.25 – $1,262.52 | 9 |
| Ghs trypsin (fecal) CPT 84488 | $18.40 | $23.00 | $4.38 – $11.35 | 7 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $779.20 | $974.00 | $175.64 – $560.20 | 11 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $1,491.20 | $1,864.00 | $204.46 – $571.87 | 9 |
| Ghs urine, hydroxproline total CPT 83505 | $61.60 | $77.00 | $14.58 – $37.81 | 7 |
| Ghs urine, porphyrins quant CPT 84120 | $64.28 | $80.35 | $8.83 – $68.30 | 9 |
| Ghs vaginal delivery only CPT 59409 | $5,598.74 | $6,998.42 | $691.99 – $5,948.66 | 11 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $452.24 – $2,098.85 | 9 |
| Ghs windowing of cast CPT 29730 | $152.00 | $190.00 | $39.77 – $134.49 | 9 |
| Giardia ag if CPT 87269 | $38.58 | $48.22 | $8.17 – $40.99 | 9 |
| Giardia lamblia antibody CPT 86674 | $48.57 | $60.71 | $8.83 – $51.60 | 9 |
| Gi endoscopic ultrasound CPT 76975 | $415.20 | $519.00 | $37.28 – $206.02 | 9 |
| Gi inhouse confirmation CPT 87045 | $38.58 | $48.22 | $5.66 – $40.99 | 9 |
| Gingivoplasty each quadrant CPT 41872 | $1,095.20 | $1,369.00 | $276.19 – $2,764.11 | 9 |
| Gi protein loss CPT 78282 | $700.00 | $875.00 | $14.21 – $342.49 | 9 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,981.60 | $2,477.00 | $102.88 – $799.09 | 9 |
| Gi trc img intral colon i&r CPT 91113 | $2,124.80 | $2,656.00 | $110.88 – $1,443.60 | 9 |
| Gi trc img intral esophagus CPT 91111 | $1,844.80 | $2,306.00 | $41.37 – $799.09 | 9 |
| Gi wireless capsule measure CPT 91112 | $3,660.00 | $4,575.00 | $96.43 – $799.09 | 9 |
| Gjb2 gene full sequence CPT 81252 | $202.40 | $253.00 | $60.67 – $141.59 | 9 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $36.91 – $86.13 | 7 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $21.00 – $48.99 | 7 |
| Glassia injection HCPCS J0257 | $10.48 | $13.10 | $0.07 – $6.00 | 9 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | $115.20 | $144.00 | $23.03 – $151.01 | 7 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | $88.00 | $110.00 | $36.91 – $98.80 | 7 |
| Glaucoma surgery CPT 66150 | $4,344.00 | $5,430.00 | $785.97 – $3,428.74 | 9 |
| Glaucoma surgery CPT 66155 | $4,340.80 | $5,426.00 | $785.35 – $3,428.74 | 9 |
| Glaucoma surgery CPT 66160 | $4,896.00 | $6,120.00 | $883.50 – $2,379.17 | 9 |
| Glaucoma surgery CPT 66170 | $5,425.60 | $6,782.00 | $981.62 – $2,639.24 | 9 |
| Glove finger flexion right lg xl HCPCS L3912 | $259.20 | $324.00 | $64.53 – $164.22 | 7 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $344.56 | $430.70 | $168.83 – $366.10 | 9 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $474.32 | $592.90 | $36.24 – $152.13 | 9 |
| Glucagon plasma - sendout CPT 82943 | $55.00 | $68.75 | $8.57 – $58.44 | 9 |
| Glucagon tolerance panel CPT 80422 | $116.00 | $145.00 | $27.64 – $71.67 | 7 |
| Glucagon tolerance panel CPT 80424 | $127.20 | $159.00 | $30.30 – $78.55 | 7 |
| Glucagon tolerance test CPT 82946 | $36.00 | $45.00 | $10.66 – $24.89 | 7 |
| Glucose 1 hr post dose CPT 82950 | $33.57 | $41.96 | $4.75 – $35.67 | 9 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $33.57 | $41.96 | $3.63 – $35.67 | 9 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $33.57 | $41.96 | $3.28 – $35.67 | 9 |
| Glucose blood quantitative CPT 82947 | $33.57 | $41.96 | $3.93 – $35.67 | 9 |
| Glucose body fluid CPT 82945 | $33.57 | $41.96 | $3.93 – $35.67 | 9 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $138.87 | $173.58 | $50.62 – $147.54 | 11 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $64.28 | $80.35 | $12.87 – $68.30 | 9 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $33.57 | $41.96 | $3.92 – $35.67 | 9 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $42.56 | $53.20 | $0.11 – $0.51 | 9 |
| Gold sodium thiomaleate inj HCPCS J1600 | $27.20 | $34.00 | $16.80 – $34.82 | 4 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $64.44 | $80.55 | $10.77 – $68.47 | 9 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $55.00 | $68.75 | $11.15 – $58.44 | 9 |
| Gonadotropin hormone panel CPT 80426 | $372.80 | $466.00 | $89.05 – $230.88 | 7 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $55.00 | $68.75 | $11.11 – $58.44 | 9 |
| Gonioscopy CPT 92020 | $58.40 | $73.00 | $18.61 – $109.87 | 9 |
| Goniotomy CPT 65820 | $3,884.80 | $4,856.00 | $732.53 – $3,428.74 | 9 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $667.20 | $834.00 | $443.67 – $791.71 | 7 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $61.60 | $77.00 | $30.36 – $44.49 | 6 |
| 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 | not published | not published | $49.54 – $198.49 | 5 |
| Graft hand or finger tendon CPT 26416 | $2,196.80 | $2,746.00 | $820.47 – $2,765.43 | 9 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | not published | not published | $31.11 – $45.04 | 3 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $391.59 – $1,997.50 | 5 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $4,573.82 | $5,717.27 | $2,241.17 – $4,859.68 | 5 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $2,957.23 | $3,696.53 | $1,449.04 – $3,142.05 | 5 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $76.00 | $95.00 | $44.16 – $65.41 | 6 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $464.36 | $580.45 | $102.78 – $493.38 | 8 |
| Graft repair of spine defect 63710 CPT 63710 | $2,615.20 | $3,269.00 | $956.26 – $2,543.05 | 7 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $535.80 | $669.75 | $136.37 – $552.87 | 8 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $97.60 | $122.00 | $46.29 – $58.50 | 6 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $149.58 – $162.08 | 2 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | not published | not published | $49.54 – $49.54 | 1 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $326.40 | $408.00 | $37.50 – $331.72 | 6 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $4,049.78 | $5,062.22 | $1,984.39 – $4,302.89 | 5 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $190.42 | $238.02 | $93.30 – $202.32 | 5 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $3.09 – $89.39 | 5 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.26 – $0.89 | 6 |
| Granulocyte pheresis ea unit HCPCS P9050 | not published | not published | $135.60 – $373.51 | 4 |
| Great toe-hand transfer CPT 26551 | not published | not published | $2,041.31 – $7,797.92 | 7 |
| Great toe with reduction 28495 CPT 28495 | $883.20 | $1,104.00 | $140.87 – $322.45 | 11 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $453.22 – $1,559.08 | 9 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | $1,417.60 | $1,772.00 | $461.50 – $3,120.29 | 9 |
| Grfg autol fat lipo ea addl CPT 15772 | $448.00 | $560.00 | $131.96 – $350.04 | 7 |
| Grfg autol soft tiss dir exc CPT 15769 | $1,188.80 | $1,486.00 | $431.39 – $3,120.29 | 9 |
| Ground mileage HCPCS A0425 | not published | not published | $8.27 – $16.08 | 6 |
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.