MercyOne New Hampton Medical Center
308 North Maple Ave, New Hampton, IA · MercyOne · · NPI 1770651515
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 |
|---|---|---|---|---|
| 99381 initial comp preventive med less than 1 year new CPT 99381 | $262.00 | $256.00 | $32.15 – $256.00 | 568 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $274.00 | $276.00 | $32.15 – $276.00 | 568 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $286.00 | $274.00 | $32.15 – $274.00 | 568 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $236.00 | $225.00 | $32.15 – $225.00 | 568 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $252.00 | $241.00 | $32.15 – $241.00 | 568 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $251.00 | $240.00 | $32.15 – $240.00 | 568 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $470.00 | $263.00 | $32.15 – $263.00 | 568 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $323.00 | $323.00 | $42.50 – $310.00 | 568 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $7,377.95 | $7,377.95 | $1,112.25 – $7,377.95 | 114 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $841.75 | $1,295.00 | $512.69 – $1,295.00 | 43 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $762.45 | $1,173.00 | $464.39 – $1,173.00 | 43 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,951.30 | $3,002.00 | $1,188.49 – $3,002.00 | 43 |
| Abdominal MRI (with and without contrast) CPT 74183 | $3,478.15 | $5,351.00 | $2,118.46 – $5,351.00 | 43 |
| Abdominal paracentesis w/image guidance CPT 49083 | $391.00 | $391.00 | $29.61 – $225.00 | 768 |
| Abdominal Ultrasound (complete) CPT 76700 | $692.90 | $1,066.00 | $422.03 – $1,066.00 | 43 |
| Abdominal Ultrasound (limited) CPT 76705 | $556.40 | $856.00 | $338.89 – $856.00 | 43 |
| Abdominal X-ray (2 views) CPT 74019 | $250.90 | $386.00 | $152.82 – $386.00 | 43 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | $327.60 | $504.00 | $199.53 – $504.00 | 43 |
| Abdominal X-ray (single view) CPT 74018 | $163.15 | $251.00 | $99.37 – $251.00 | 43 |
| Ablation of upper extremity nerves rf CPT 64999 | $551.20 | $848.00 | $335.72 – $848.00 | 43 |
| Acetaminophen 120 mg rectal suppository HCPCS A9270 | $5,017.61 | $2,532.65 | $0.32 – $2.46 | 114 |
| Acetone qualitative CPT 82009 | $42.25 | $65.00 | $25.73 – $65.00 | 43 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $244.95 | $244.95 | $22.20 – $244.95 | 114 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $424.00 | $424.00 | $119.30 – $424.00 | 779 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $1,177.15 | $386.00 | $47.03 – $332.00 | 779 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | $31.85 | $49.00 | $19.40 – $49.00 | 43 |
| Acute hepatitis panel CPT 80074 | $316.55 | $487.00 | $192.80 – $487.00 | 43 |
| Acyclovir 400 mg tablet HCPCS J8499 | $1.00 | $1.00 | $0.40 – $1.00 | 43 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $4.20 | $4.20 | $0.90 – $4.20 | 114 |
| Adapter b 8 channel 10cm HCPCS C1883 | $23,107.50 | $35,550.00 | $0.02 – $0.04 | 43 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $695.70 | $695.70 | $2.97 – $7.50 | 43 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $78.60 | $78.60 | $0.22 – $1.00 | 114 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $340.60 | $524.00 | $207.45 – $524.00 | 43 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $543.40 | $836.00 | $330.97 – $836.00 | 43 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $271.05 | $417.00 | $165.09 – $417.00 | 43 |
| Administration immunization each additional component CPT 90461 | $27.95 | $43.00 | $7.79 – $19.68 | 43 |
| Administration immunization each additional vaccine CPT 90472 | $65.00 | $100.00 | $4.32 – $29.00 | 779 |
| Administration immunization first component each vaccine CPT 90460 | $55.00 | $65.00 | $7.79 – $51.74 | 779 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $46.80 | $72.00 | $7.28 – $42.00 | 779 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $27.95 | $43.00 | $5.83 – $23.00 | 779 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $39.00 | $60.00 | $7.79 – $19.68 | 43 |
| Administration vaccine hepatitis b HCPCS G0010 | $57.20 | $88.00 | $7.79 – $19.68 | 43 |
| Administration vaccine influenza virus HCPCS G0008 | $78.00 | $88.00 | $5.09 – $39.00 | 779 |
| Administration vaccine pneumococcal HCPCS G0009 | $78.00 | $88.00 | $5.09 – $39.00 | 779 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $56.46 | $43.00 | $7.79 – $36.00 | 779 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $19,916.25 | $19,916.25 | $4,580.00 – $12,447.70 | 114 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $18,756.30 | $18,756.30 | $7,425.62 – $18,756.30 | 114 |
| Air conduction bilat CPT 92552 | $14.30 | $22.00 | $8.71 – $22.00 | 43 |
| Albumin body fluid quantitative each specimen CPT 82042 | $47.45 | $73.00 | $7.62 – $73.00 | 43 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $200.00 | $200.00 | $79.18 – $200.00 | 43 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $332.50 | $332.50 | $65.82 – $166.25 | 43 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $57.20 | $88.00 | $34.84 – $88.00 | 43 |
| Albumin serum plasma or whole blood CPT 82040 | $57.85 | $89.00 | $35.24 – $89.00 | 43 |
| Albuterol ipratrop non-comp HCPCS J7620 | $2.70 | $1.00 | $0.12 – $1.00 | 767 |
| Albuterol non-comp unit HCPCS J7613 | $1.00 | $1.00 | $0.04 – $1.00 | 767 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $94.90 | $146.00 | $57.80 – $146.00 | 43 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $89,232.75 | $89,232.75 | $29,288.40 – $89,232.75 | 114 |
| Alkaline phosphatase CPT 84075 | $40.95 | $63.00 | $24.94 – $63.00 | 43 |
| Allergen alpha lactalbumin ige CPT 86008 | $31.20 | $48.00 | $17.57 – $48.00 | 43 |
| Allergen egg white ige CPT 86003 | $28.60 | $44.00 | $17.42 – $44.00 | 43 |
| Allergy injections; 2 or more 95117 CPT 95117 | $40.00 | $50.00 | $7.87 – $50.00 | 779 |
| Allergy injection; single 95115 CPT 95115 | $34.00 | $51.00 | $6.59 – $51.00 | 779 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $34.61 | $53.24 | $21.08 – $53.24 | 43 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $528.94 | $813.75 | $95.32 – $240.77 | 43 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $3,763.50 | $5,790.00 | $53.48 – $135.08 | 43 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,480.75 | $5,355.00 | $11.75 – $29.68 | 43 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $165.65 | $254.84 | $9.14 – $23.08 | 43 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $1,492.97 | $2,296.88 | $29.58 – $74.72 | 43 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $292.91 | $450.63 | $82.24 – $207.73 | 43 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $5,330.00 | $8,200.00 | $381.05 – $962.50 | 43 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $279.64 | $430.22 | $147.23 – $371.88 | 43 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $1,015.79 | $1,562.75 | $296.91 – $749.95 | 43 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $2,450.00 | $2,450.00 | $969.96 – $2,450.00 | 43 |
| Alpha-fetoprotein tumor marker CPT 82105 | $129.35 | $199.00 | $78.78 – $199.00 | 43 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $25,477.05 | $25,477.05 | $188.30 – $562.90 | 113 |
| Alt/sgpt CPT 84460 | $67.60 | $104.00 | $41.17 – $104.00 | 43 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $101.15 | $101.15 | $7.26 – $18.35 | 43 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $212.00 | $212.00 | $31.32 – $212.00 | 114 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $3.90 | $3.90 | $1.54 – $3.90 | 114 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $11,933.95 | $11,933.95 | $4,252.50 – $11,933.95 | 114 |
| Ammonia CPT 82140 | $154.70 | $238.00 | $14.42 – $238.00 | 43 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $8.75 | $8.75 | $3.46 – $34.12 | 114 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $562.35 | $562.35 | $222.63 – $562.35 | 43 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $38.85 | $38.85 | $0.98 – $5.90 | 114 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $24.65 | $24.65 | $2.51 – $6.35 | 114 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $512.85 | $789.00 | $273.19 – $789.00 | 43 |
| Amputation toe interphalangeal joint CPT 28825 | $4,693.79 | not published | $0.50 – $31.45 | 72 |
| Amylase CPT 82150 | $71.50 | $110.00 | $43.55 – $110.00 | 43 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $154.05 | $237.00 | $93.83 – $237.00 | 43 |
| Analysis gene f2 20210g>a variant CPT 81240 | $110.50 | $170.00 | $67.30 – $170.00 | 43 |
| Analysis gene f5 leiden variant CPT 81241 | $379.60 | $584.00 | $231.21 – $584.00 | 43 |
| Anchor suture 3.5mm pushlock HCPCS C1741 | $2,047.50 | $3,150.00 | $593.11 – $1,498.13 | 43 |
| Ankle X-ray CPT 73610 | $407.55 | $627.00 | $165.49 – $418.00 | 43 |
| Annual Physical, Established Patient (age 18-39) CPT 99395 | $216.00 | $269.00 | $42.50 – $269.00 | 568 |
| Annual Physical, Established Patient (age 40-64) CPT 99396 | $235.00 | $287.00 | $42.50 – $287.00 | 568 |
| Annual Physical, New Patient (age 18-39) CPT 99385 | $237.00 | $301.00 | $65.44 – $301.00 | 568 |
| Annual Physical, New Patient (age 40-64) CPT 99386 | $288.00 | $349.00 | $66.40 – $349.00 | 568 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $257.40 | $396.00 | $156.78 – $396.00 | 43 |
| Antibody id rbc panel CPT 86870 | $291.85 | $449.00 | $177.76 – $449.00 | 42 |
| Antibody screen rbc CPT 86850 | $85.80 | $132.00 | $52.26 – $132.00 | 43 |
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.