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 |
|---|---|---|---|---|
| Initial nursing facility care/day low severity 99304 CPT 99304 | $137.80 | $212.00 | $83.93 – $212.00 | 43 |
| Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 | $1,686.75 | $2,595.00 | $23.10 – $691.00 | 780 |
| Injection carpal tunnel therapeutic (both sides) CPT 20526 | $779.35 | $1,199.00 | $14.45 – $799.00 | 780 |
| Injection,onabotulinumtoxina HCPCS J0585 | $3,255.00 | $3,255.00 | $1,288.65 – $3,255.00 | 43 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | $1,126.45 | $1,733.00 | $457.26 – $1,155.00 | 43 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $21,780.02 | $1,725.00 | $0.96 – $513.00 | 780 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,767.50 | $1,485.00 | $0.50 – $294.00 | 780 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $6,399.90 | $9,846.00 | $25.81 – $6,564.00 | 780 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $5,964.15 | $3,200.00 | $0.50 – $2,133.00 | 780 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $5,856.90 | $4,473.00 | $0.50 – $2,982.00 | 780 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $6,848.28 | $3,879.00 | $0.50 – $225.00 | 780 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $4,058.23 | $3,861.00 | $0.50 – $510.00 | 780 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $1,781.55 | $1,549.00 | $3.44 – $736.00 | 780 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,006.85 | $1,549.00 | $28.44 – $736.00 | 780 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $779.35 | $1,199.00 | $9.16 – $136.00 | 780 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $1,142.05 | $999.00 | $3.44 – $184.00 | 780 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $742.30 | $1,142.00 | $37.97 – $332.00 | 43 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $8,725.63 | $224.00 | $9.84 – $224.00 | 114 |
| Inject sacroiliac joint CPT 27096 | $877.50 | $1,350.00 | $23.54 – $900.00 | 780 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $227.50 | $350.00 | $81.74 – $350.00 | 43 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $1,736.15 | $2,671.00 | $1,057.45 – $2,671.00 | 43 |
| Inj labetalol hcl hikma, 5mg HCPCS J1921 | $15.00 | $15.00 | $5.94 – $15.00 | 43 |
| Inj testosterone cypionate HCPCS J1071 | $200.00 | $200.00 | $0.02 – $44.25 | 767 |
| Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln HCPCS J9229 | $73,182.85 | $73,182.85 | $26,573.31 – $73,182.85 | 114 |
| Insert drug delivery implant CPT 11981 | $571.70 | $373.00 | $2.79 – $373.00 | 780 |
| Insert intrauterine device iud CPT 58300 | $380.00 | $550.00 | $4.46 – $550.00 | 780 |
| Insertion catheter pleural indwelling tunneled with cuff CPT 32550 | $602.55 | $927.00 | $167.97 – $927.00 | 43 |
| Insole orthotic freedom sz6 6816 HCPCS L3060 | $35.44 | $54.52 | $21.58 – $54.52 | 43 |
| Insulin total CPT 83525 | $85.80 | $132.00 | $52.26 – $132.00 | 43 |
| Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm HCPCS Q4114 | $2,217.37 | $3,411.34 | $1,350.55 – $3,411.34 | 43 |
| Integra os putty 2.5cc - cost per 0.5cc HCPCS C9359 | $152.42 | $234.50 | $92.84 – $234.50 | 43 |
| Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper) HCPCS Q3027 | $10,427.90 | $10,427.90 | $2,159.40 – $10,427.90 | 114 |
| Intrinsic factor antibody CPT 86340 | $122.20 | $188.00 | $14.78 – $188.00 | 43 |
| Intubation endotracheal emergency procedure CPT 31500 | $450.00 | $450.00 | $13.56 – $47.84 | 768 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $1,773.82 | $1,034.00 | $3.44 – $1,034.00 | 114 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $220.25 | $220.25 | $46.42 – $117.25 | 43 |
| Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 | $110,829.85 | $110,829.85 | $10,036.00 – $27,707.50 | 114 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $522.90 | $522.90 | $25.32 – $63.95 | 43 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | $9,268.95 | $9,268.95 | $3,070.63 – $9,268.95 | 114 |
| Iron CPT 83540 | $53.30 | $82.00 | $32.46 – $82.00 | 43 |
| Iron binding capacity CPT 83550 | $63.05 | $97.00 | $38.40 – $97.00 | 43 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $185.90 | $185.90 | $73.60 – $185.90 | 43 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $82.80 | $82.80 | $22.00 – $82.80 | 114 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $163.15 | $251.00 | $99.37 – $251.00 | 43 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | $2,779.35 | $2,779.35 | $906.80 – $2,779.35 | 114 |
| IV Fluids (each additional hour) CPT 96361 | $846.30 | $152.00 | $4.56 – $152.00 | 114 |
| IV Fluids (first hour) CPT 96360 | $505.70 | $369.00 | $1.38 – $369.00 | 114 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $113.10 | $174.00 | $68.89 – $174.00 | 43 |
| IV Medicine Infusion (additional drug) CPT 96367 | $191.10 | $294.00 | $116.39 – $294.00 | 43 |
| IV Medicine Infusion (each additional hour) CPT 96366 | $3,726.64 | $149.00 | $4.40 – $149.00 | 114 |
| IV Medicine Infusion (first hour) CPT 96365 | $1,434.35 | $445.00 | $158.10 – $445.00 | 114 |
| IV Push Injection (each additional drug) CPT 96375 | $11,543.25 | $192.00 | $76.01 – $1,654.50 | 114 |
| IV Push Injection (first drug) CPT 96374 | $1,308.77 | $310.00 | $26.00 – $310.00 | 114 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | $18,131.05 | $18,131.05 | $2,276.25 – $6,043.70 | 114 |
| Jkt lso inter HCPCS L0560 | $48.98 | $75.36 | $29.84 – $75.36 | 43 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $72.80 | $112.00 | $44.34 – $112.00 | 43 |
| Ketorolac (Toradol) Pain Shot, 15 mg HCPCS J1885 | $17.25 | $17.25 | $0.29 – $5.73 | 779 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $603.85 | $929.00 | $367.79 – $929.00 | 43 |
| Kidney (Retroperitoneal) Ultrasound (limited) CPT 76775 | $261.09 | $241.00 | $17.25 – $60.00 | 768 |
| Kit case 4.2mm spinejack HCPCS C1062 | $5,641.23 | $8,678.82 | $1,102.95 – $2,785.92 | 43 |
| Kit cast tcc 3in w/2reg boots total contact cast HCPCS Q4038 | $267.13 | $410.97 | $140.09 – $353.85 | 43 |
| Kit cath f 8f w/glv + wipe ster HCPCS A4353 | $5.25 | $8.08 | $2.11 – $5.32 | 43 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $6,110.00 | $9,400.00 | $2,177.45 – $5,500.00 | 43 |
| Kit hfx iq ipg bundle HCPCS C1822 | $30,880.20 | $47,508.00 | $18,120.34 – $45,770.00 | 43 |
| Kit ipg optimizer smart HCPCS C1824 | $33,800.00 | $52,000.00 | $18,211.40 – $46,000.00 | 43 |
| Kit irrigator stoma cone 7721 HCPCS A4398 | $8.22 | $12.64 | $5.00 – $12.64 | 43 |
| Kit lead specify 5-6-5 HCPCS C1778 | $12,783.33 | $19,666.66 | $67.35 – $170.12 | 43 |
| Kit monitr cath camino icp w/integratd licox bolt fitting HCPCS A9279 | $1,168.83 | $1,798.20 | $711.91 – $1,798.20 | 43 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $1,238.25 | $1,905.00 | $723.98 – $1,828.70 | 43 |
| Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm HCPCS Q4105 | $243.11 | $374.01 | $86.69 – $218.96 | 43 |
| Kit sound processor cochlear osia 2 HCPCS L8691 | $5,801.69 | $8,925.68 | $2,394.40 – $6,048.00 | 43 |
| Kit trach suct cls 30.5cm HCPCS A4605 | $2,983.50 | $4,590.00 | $13.25 – $33.48 | 43 |
| Knee Arthroscopy (Meniscus Trimming) CPT 29881 | $9,979.22 | not published | $0.96 – $3.36 | 72 |
| Knee MRI (with and without contrast) CPT 73723 | $4,938.70 | $7,598.00 | $2,026.00 – $5,065.00 | 42 |
| Knee MRI (without contrast) CPT 73721 | $3,903.25 | $6,005.00 | $1,584.79 – $4,003.00 | 43 |
| Knee X-ray CPT 73564 | $483.60 | $744.00 | $196.37 – $496.00 | 43 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $266.50 | $410.00 | $108.08 – $273.00 | 43 |
| Knee X-ray (3 views, both knees) CPT 73562 | $319.15 | $491.00 | $129.46 – $327.00 | 43 |
| Lactate dehydrogenase (ldh) CPT 83615 | $48.75 | $75.00 | $6.04 – $75.00 | 43 |
| Lactated ringers intravenous solution HCPCS J7120 | $20.00 | $20.00 | $7.92 – $20.00 | 43 |
| Lactic acid CPT 83605 | $1,172.60 | $126.00 | $9.09 – $126.00 | 43 |
| Lactoferrin fecal qualitative CPT 83630 | $126.75 | $195.00 | $19.31 – $195.00 | 43 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | $29,832.00 | $29,832.00 | $11,810.49 – $29,832.00 | 43 |
| Large Joint Injection or Fluid Draw (both sides) CPT 20610 | $1,397.50 | $1,326.00 | $3.44 – $223.00 | 781 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $2,730.00 | $4,200.00 | $47.49 – $119.96 | 43 |
| Lead capillary CPT 83655 | $90.35 | $139.00 | $9.20 – $139.00 | 780 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $3,952.26 | $6,080.40 | $0.41 – $1.04 | 43 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $7,793.50 | $11,990.00 | $43.90 – $110.88 | 43 |
| Leg Artery Ultrasound (complete, both legs) CPT 93925 | $880.75 | $1,355.00 | $536.44 – $1,355.00 | 43 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $2,269.15 | $3,491.00 | $921.26 – $2,327.00 | 43 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $2,120.95 | $3,263.00 | $861.08 – $2,175.00 | 43 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $987.35 | $1,519.00 | $601.37 – $1,519.00 | 43 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $419.25 | $645.00 | $19.80 – $50.00 | 43 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $692.25 | $1,065.00 | $19.80 – $50.00 | 43 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $487.50 | $750.00 | $19.80 – $50.00 | 43 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $396.40 | $396.40 | $3.95 – $13.75 | 114 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $37,312.35 | $37,312.35 | $138.82 – $350.65 | 114 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $5,218.50 | $5,218.50 | $1,737.10 – $5,218.50 | 114 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $48.30 | $48.30 | $2.25 – $7.95 | 114 |
| Levetiracetam therapeutic drug level CPT 80177 | $130.00 | $200.00 | $79.18 – $200.00 | 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.