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 |
|---|---|---|---|---|
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $61.50 | $61.50 | $1.96 – $6.50 | 114 |
| Liberta rc ipg HCPCS C1820 | $34,769.50 | $53,491.54 | $32.29 – $81.56 | 43 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $37.50 | $37.50 | $14.85 – $37.50 | 43 |
| Lidocaine therapeutic drug level CPT 80176 | $43.55 | $67.00 | $26.53 – $67.00 | 43 |
| Lift heel adj small gl60404sm HCPCS L3332 | $45.50 | $70.00 | $27.71 – $70.00 | 43 |
| Lift heel adjustable med HCPCS L3334 | $12.12 | $18.64 | $7.38 – $18.64 | 43 |
| Lipase CPT 83690 | $83.20 | $128.00 | $50.68 – $128.00 | 43 |
| Lipoprotein direct measurement hdl CPT 83718 | $62.40 | $96.00 | $8.03 – $96.00 | 43 |
| Lipoprotein direct measurement ldl CPT 83721 | $453.05 | $96.00 | $9.09 – $96.00 | 43 |
| Lithium therapeutic drug level CPT 80178 | $61.10 | $94.00 | $37.21 – $94.00 | 43 |
| Liver Function Test CPT 80076 | $110.50 | $170.00 | $67.30 – $170.00 | 43 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | $87,089.35 | $87,089.35 | $31,546.27 – $87,089.35 | 114 |
| Loop ostmy bridg ster HCPCS A4421 | $45.55 | $70.08 | $0.73 – $1.44 | 33 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $60.90 | $60.90 | $2.10 – $5.30 | 114 |
| Low-Dose Lung Cancer Screening CT Scan CPT 71271 | $1,402.05 | $2,157.00 | $853.96 – $2,157.00 | 43 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,824.55 | $2,807.00 | $1,111.29 – $2,807.00 | 43 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,517.10 | $2,334.00 | $924.03 – $2,334.00 | 43 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,803.15 | $5,851.00 | $2,316.41 – $5,851.00 | 42 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,598.70 | $3,998.00 | $1,582.81 – $3,998.00 | 43 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $286.00 | $440.00 | $174.20 – $440.00 | 43 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $369.20 | $568.00 | $224.87 – $568.00 | 43 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $295.75 | $455.00 | $119.96 – $303.00 | 43 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $453.05 | $697.00 | $275.94 – $697.00 | 43 |
| Lung Function Test (Spirometry) CPT 94010 | $221.65 | $341.00 | $135.00 – $341.00 | 43 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $25,230.00 | $25,230.00 | $9,022.80 – $25,230.00 | 114 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $37,758.50 | $37,758.50 | $4,196.00 – $12,586.20 | 114 |
| Lvad shower bag heartmate HCPCS Q0501 | $1,105.65 | $1,701.00 | $673.43 – $1,701.00 | 43 |
| Magnesium CPT 83735 | $69.55 | $107.00 | $42.36 – $107.00 | 43 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $75.00 | $75.00 | $1.00 – $4.25 | 114 |
| Mammosite ced HCPCS C1728 | $1,278.87 | $1,967.50 | $778.93 – $1,967.50 | 43 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | $8,622.65 | $8,622.65 | $2,760.50 – $8,622.65 | 114 |
| Marker biop eviva buckle ss HCPCS A4648 | $3,147.62 | $4,842.50 | $0.02 – $0.04 | 43 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | $1,123.61 | $1,728.63 | $684.36 – $1,728.63 | 43 |
| Mask full face lg af531 HCPCS A7030 | $56.19 | $86.44 | $33.38 – $84.32 | 43 |
| Matrix bone cryomatrix 2.0ml HCPCS Q4162 | $6,193.20 | $9,528.00 | $3,772.14 – $9,528.00 | 43 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $86.55 | $133.16 | $5.72 – $14.44 | 43 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $81.90 | $126.00 | $49.88 – $126.00 | 43 |
| Mayo aathr protein s free CPT 85306 | $153.40 | $236.00 | $93.43 – $236.00 | 43 |
| Mayo activated protein c resistance assay CPT 85307 | $128.05 | $197.00 | $15.01 – $197.00 | 43 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $97.50 | $150.00 | $59.39 – $150.00 | 43 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $108.55 | $167.00 | $66.12 – $167.00 | 43 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $101.40 | $156.00 | $61.76 – $156.00 | 43 |
| Mayo alpha 1 antitrypsin CPT 82103 | $124.80 | $192.00 | $13.17 – $192.00 | 43 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $240.50 | $370.00 | $146.48 – $370.00 | 43 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $561.60 | $864.00 | $91.66 – $864.00 | 43 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $118.95 | $183.00 | $72.45 – $183.00 | 43 |
| Mayo antithrombin iii antigen CPT 85301 | $157.95 | $243.00 | $96.20 – $243.00 | 43 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $142.35 | $219.00 | $14.75 – $219.00 | 43 |
| Mayo avwpr vw factor activity CPT 85397 | $229.45 | $353.00 | $30.24 – $353.00 | 43 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $77.35 | $119.00 | $10.18 – $119.00 | 29 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $90.35 | $139.00 | $55.03 – $139.00 | 43 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $317.20 | $488.00 | $193.20 – $488.00 | 43 |
| Mayo ceruloplasmin CPT 82390 | $71.50 | $110.00 | $43.55 – $110.00 | 43 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $122.20 | $188.00 | $74.43 – $188.00 | 43 |
| Mayo coccidioides antibody CPT 86635 | $68.90 | $106.00 | $34.84 – $88.00 | 43 |
| Mayo cocou cortisone urine CPT 82542 | $186.55 | $287.00 | $23.61 – $287.00 | 43 |
| Mayo cortisol free CPT 82530 | $109.85 | $169.00 | $16.71 – $144.00 | 43 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $91.65 | $141.00 | $41.29 – $141.00 | 43 |
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | $105.30 | $162.00 | $64.14 – $162.00 | 43 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $271.70 | $418.00 | $12.99 – $418.00 | 43 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $148.20 | $228.00 | $24.76 – $228.00 | 43 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $68.25 | $105.00 | $16.01 – $105.00 | 43 |
| Mayo everolimus therapeutic drug level CPT 80169 | $125.45 | $193.00 | $13.46 – $193.00 | 43 |
| Mayo factor ii CPT 85210 | $91.65 | $141.00 | $12.72 – $141.00 | 43 |
| Mayo factor v CPT 85220 | $91.65 | $141.00 | $55.82 – $141.00 | 43 |
| Mayo factor vii CPT 85230 | $91.65 | $141.00 | $23.81 – $141.00 | 43 |
| Mayo factor viii vw factor antigen CPT 85246 | $178.10 | $274.00 | $108.48 – $274.00 | 43 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $218.40 | $336.00 | $133.02 – $336.00 | 43 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $231.40 | $356.00 | $140.94 – $356.00 | 43 |
| Mayo factor x CPT 85260 | $109.85 | $169.00 | $17.54 – $169.00 | 43 |
| Mayo factor xi CPT 85270 | $122.20 | $188.00 | $17.54 – $188.00 | 43 |
| Mayo fat/lipids feces quantitative CPT 82710 | $109.20 | $168.00 | $66.51 – $168.00 | 43 |
| Mayo fbl culture fungi blood CPT 87103 | $106.60 | $164.00 | $64.93 – $164.00 | 43 |
| Mayo ffspg allergen clam igg CPT 86001 | $142.35 | $219.00 | $86.70 – $219.00 | 43 |
| Mayo fibrinogen antigen CPT 85385 | $26.00 | $40.00 | $14.17 – $40.00 | 43 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $226.85 | $349.00 | $138.17 – $349.00 | 43 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | $33.80 | $52.00 | $20.59 – $52.00 | 43 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $57.85 | $89.00 | $35.24 – $89.00 | 43 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $120.90 | $186.00 | $73.64 – $186.00 | 43 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $84.50 | $130.00 | $51.47 – $130.00 | 43 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $144.95 | $223.00 | $26.63 – $223.00 | 43 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $135.20 | $208.00 | $82.35 – $208.00 | 43 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $130.00 | $200.00 | $79.18 – $200.00 | 43 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $148.20 | $228.00 | $20.39 – $228.00 | 43 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $59.80 | $92.00 | $31.67 – $80.00 | 43 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $133.90 | $206.00 | $81.56 – $206.00 | 43 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | $229.45 | $353.00 | $139.75 – $353.00 | 43 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $253.50 | $390.00 | $34.39 – $390.00 | 43 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $229.45 | $353.00 | $41.98 – $353.00 | 43 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $295.10 | $454.00 | $179.74 – $454.00 | 43 |
| Mayo infliximab therapeutic drug level CPT 80230 | $234.00 | $360.00 | $142.52 – $360.00 | 43 |
| Mayo insulin antibodies CPT 86337 | $133.90 | $206.00 | $20.98 – $206.00 | 43 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $202.15 | $311.00 | $26.57 – $311.00 | 43 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $175.50 | $270.00 | $106.89 – $270.00 | 43 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $14.30 | $22.00 | $8.71 – $22.00 | 29 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $65.00 | $100.00 | $39.59 – $100.00 | 43 |
| Mayo lipoprotein electrophoresis CPT 83700 | $78.00 | $120.00 | $11.03 – $120.00 | 43 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $102.70 | $158.00 | $15.49 – $158.00 | 43 |
| Mayo metanephrines plasma CPT 83835 | $170.95 | $263.00 | $104.12 – $263.00 | 43 |
| Mayo mgle voltage-gated calcium channel antibody each CPT 86596 | $84.50 | $130.00 | $51.47 – $130.00 | 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.