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 |
|---|---|---|---|---|
| Skull X-ray (1 to 3 views) CPT 70250 | $193.05 | $297.00 | $117.58 – $297.00 | 43 |
| Skyla, 13.5 mg HCPCS J7301 | $5,297.60 | $5,297.60 | $543.47 – $1,358.67 | 535 |
| Sleep Study (Polysomnography) CPT 95810 | $3,901.30 | $6,002.00 | $2,376.19 – $6,002.00 | 43 |
| Sleep study unattended CPT 95806 | $565.00 | $832.00 | $28.54 – $832.00 | 779 |
| Sleeve fing rolyan med HCPCS L3933 | $44.69 | $68.76 | $27.22 – $68.76 | 43 |
| Sleeve irr assura 1pc disp HCPCS A4397 | $2.60 | $4.00 | $1.58 – $4.00 | 43 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $658.98 | $1,013.81 | $3.28 – $8.28 | 43 |
| Sling pelv split sam med HCPCS L0621 | $171.94 | $264.53 | $104.73 – $264.53 | 43 |
| Sling suprapubic suburetheral HCPCS C1771 | $9,197.11 | $14,149.40 | $719.15 – $1,816.50 | 43 |
| Slp pure tone screening CPT 92551 | $29.90 | $46.00 | $18.21 – $46.00 | 43 |
| Sm-153 lexidron ther HCPCS A9604 | $57,456.00 | $57,456.00 | $4,314.91 – $57,456.00 | 114 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $50.70 | $78.00 | $5.34 – $78.00 | 43 |
| Smear gram stain CPT 87205 | $35.75 | $55.00 | $21.77 – $55.00 | 43 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $64.35 | $99.00 | $5.87 – $99.00 | 43 |
| Smear wet mount CPT 87210 | $41.60 | $64.00 | $25.34 – $64.00 | 43 |
| Sock wool above knee HCPCS L8430 | $164.80 | $253.54 | $100.38 – $253.54 | 43 |
| Sodium 24 hour urine CPT 84300 | $74.10 | $114.00 | $45.13 – $114.00 | 43 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $25.00 | $25.00 | $5.15 – $13.00 | 43 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $22.50 | $22.50 | $7.92 – $20.00 | 43 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $34.50 | $34.50 | $6.93 – $17.50 | 43 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $30.00 | $30.00 | $4.95 – $75.00 | 114 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $40.85 | $40.85 | $10.90 – $40.85 | 114 |
| Sodium serum/plasma/whole blood CPT 84295 | $196.95 | $61.00 | $9.09 – $61.00 | 43 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $495.00 | $495.00 | $105.00 – $495.00 | 114 |
| Specific gravity body fluid CPT 84315 | $30.55 | $47.00 | $18.61 – $47.00 | 43 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $428.35 | $659.00 | $260.90 – $659.00 | 43 |
| Speech Therapy Session (one-on-one) CPT 92507 | $245.70 | $378.00 | $149.65 – $378.00 | 43 |
| Splint arm vnyl coated padded lft med HCPCS Q4051 | $13.00 | $20.00 | $7.92 – $20.00 | 43 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $34.48 | $53.04 | $9.25 – $23.36 | 43 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $59.80 | $92.00 | $12.51 – $31.60 | 43 |
| Splint finger 4 prong foam sm HCPCS A4570 | $2.21 | $3.40 | $1.06 – $2.68 | 43 |
| Splint finger fold over sm HCPCS L3924 | $1.74 | $2.68 | $1.06 – $2.68 | 43 |
| Splint finger frog med HCPCS L3927 | $2.16 | $3.32 | $0.62 – $1.56 | 43 |
| Splint fing stax assort 1-7in HCPCS Q4049 | $4.16 | $6.40 | $2.53 – $6.40 | 43 |
| Splint func pos polyflex ii med HCPCS L3999 | $26.88 | $41.36 | $16.37 – $41.36 | 43 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $120.09 | $184.76 | $15.31 – $38.68 | 43 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $40,862.00 | $40,862.00 | $15,000.00 – $40,862.00 | 114 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $286.65 | $441.00 | $174.59 – $441.00 | 43 |
| Staph a dna amp probe CPT 87640 | $100.10 | $154.00 | $60.97 – $154.00 | 43 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $408.85 | $629.00 | $249.02 – $629.00 | 43 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $37,700.00 | $58,000.00 | $0.02 – $0.04 | 43 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $5,760.86 | $8,862.86 | $9.42 – $23.80 | 43 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $21,773.70 | $33,498.00 | $3.67 – $9.28 | 43 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $4,673.50 | $7,190.00 | $415.70 – $1,050.00 | 43 |
| St evaluate speech sound production CPT 92522 | $336.70 | $518.00 | $205.08 – $518.00 | 43 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $312.65 | $481.00 | $190.43 – $481.00 | 43 |
| Strap chin dlx f/cpap HCPCS A7036 | $27.92 | $42.96 | $17.01 – $42.96 | 43 |
| Strap montgmry ns 8 hl sht 7.25 x 11.25in HCPCS A4461 | $1.01 | $1.55 | $0.61 – $1.55 | 43 |
| Strep a ag ia CPT 87430 | $66.30 | $102.00 | $40.38 – $102.00 | 43 |
| Stress test pulmonary CPT 94618 | $273.65 | $421.00 | $166.67 – $421.00 | 43 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $77.20 | $77.20 | $30.56 – $77.20 | 43 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $17.70 | $17.70 | $7.01 – $49.00 | 114 |
| Support clav 29.6-40.5in med HCPCS L3650 | $111.80 | $172.00 | $5.16 – $13.04 | 43 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $122.20 | $188.00 | $74.43 – $188.00 | 43 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $178.10 | $274.00 | $31.45 – $274.00 | 43 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $321.10 | $494.00 | $195.57 – $494.00 | 42 |
| Susceptibility mic per plate CPT 87186 | $89.70 | $138.00 | $54.63 – $138.00 | 43 |
| Swallowing Evaluation (Bedside) CPT 92610 | $293.15 | $451.00 | $178.55 – $451.00 | 43 |
| Swallowing Therapy Session CPT 92526 | $221.00 | $340.00 | $134.61 – $340.00 | 43 |
| Synvisc or synvisc-one HCPCS J7325 | $6,298.90 | $6,298.90 | $6.61 – $6,298.90 | 779 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $21.45 | $33.00 | $4.31 – $33.00 | 43 |
| System cardiomems hosp electronics HCPCS C2624 | $27,950.00 | $43,000.00 | $5,949.43 – $15,027.60 | 43 |
| System pacing micra av HCPCS C1786 | $19,500.00 | $30,000.00 | $36.42 – $92.00 | 43 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $31,528.90 | $48,506.00 | $51.67 – $130.52 | 43 |
| System recell skin grafting/harvesting HCPCS C1832 | $8,508.50 | $13,090.00 | $5,182.33 – $13,090.00 | 43 |
| System sealant biosentry tract HCPCS C2613 | $812.54 | $1,250.06 | $494.90 – $1,250.06 | 43 |
| T3 (triiodothyronine) free CPT 84481 | $122.20 | $188.00 | $74.43 – $188.00 | 43 |
| T3 (triiodothyronine) total CPT 84480 | $96.85 | $149.00 | $58.99 – $149.00 | 43 |
| T4 (thyroxine) free CPT 84439 | $78.65 | $121.00 | $47.90 – $121.00 | 43 |
| T4 (thyroxine) total CPT 84436 | $52.65 | $81.00 | $32.07 – $81.00 | 43 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $1,208.10 | $1,208.10 | $262.23 – $1,208.10 | 114 |
| Tacrolimus therapeutic drug level CPT 80197 | $158.60 | $244.00 | $96.60 – $244.00 | 43 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | $4,272.00 | $4,272.00 | $1,540.00 – $4,272.00 | 114 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $221.65 | $341.00 | $135.00 – $341.00 | 43 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | $88,021.00 | $88,021.00 | $321.96 – $880.35 | 114 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | $35,941.50 | $35,941.50 | $868.80 – $4,492.75 | 114 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | $12.14 | $18.68 | $9.43 – $18.68 | 33 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $46,350.00 | $46,350.00 | $1,715.37 – $4,635.00 | 114 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $463.10 | $463.10 | $90.00 – $289.40 | 114 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $221.65 | $341.00 | $98.00 – $341.00 | 43 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $164.45 | $253.00 | $100.16 – $253.00 | 43 |
| Tc-99m apcitide diag HCPCS A9504 | $1,765.30 | $1,765.30 | $698.88 – $1,765.30 | 43 |
| Tc-99m arcitumomab HCPCS A9568 | $4,224.15 | $4,224.15 | $1,672.34 – $4,224.15 | 43 |
| Tc-99m bicisate HCPCS A9557 | $7,128.20 | $7,128.20 | $2,822.05 – $7,128.20 | 43 |
| Tc-99m depreotide HCPCS A9536 | $1,937.35 | $1,937.35 | $767.00 – $1,937.35 | 43 |
| Tc-99m diag per dose HCPCS A4641 | $575.50 | $575.50 | $227.84 – $575.50 | 43 |
| Tc-99m disofenin HCPCS A9510 | $339.80 | $339.80 | $134.53 – $339.80 | 43 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $8,194.15 | $8,194.15 | $3,244.06 – $8,194.15 | 43 |
| Tc-99m exametazime diag HCPCS A9521 | $7,382.05 | $7,382.05 | $2,922.55 – $7,382.05 | 43 |
| Tc-99m fanolesomab diag HCPCS A9566 | $17,688.75 | $17,688.75 | $7,002.98 – $17,688.75 | 43 |
| Tc-99m gluceptate HCPCS A9550 | $1,105.40 | $1,105.40 | $437.63 – $1,105.40 | 43 |
| Tc-99m labeled rbc HCPCS A9560 | $857.40 | $857.40 | $339.44 – $857.40 | 43 |
| Tc-99m maa HCPCS A9540 | $760.95 | $760.95 | $301.26 – $760.95 | 43 |
| Tc-99m mebrofenin HCPCS A9537 | $308.25 | $308.25 | $122.04 – $308.25 | 43 |
| Tc-99m medronate HCPCS A9503 | $210.35 | $210.35 | $83.28 – $210.35 | 43 |
| Tc-99m mertiatide HCPCS A9562 | $1,340.90 | $1,340.90 | $530.86 – $1,340.90 | 43 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $1.00 | $1.00 | $0.40 – $1.00 | 43 |
| Tc-99m oxidronate HCPCS A9561 | $199.60 | $199.60 | $79.02 – $199.60 | 43 |
| Tc-99m pentetate dtpa HCPCS A9539 | $627.25 | $627.25 | $248.33 – $627.25 | 43 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $627.25 | $627.25 | $248.33 – $627.25 | 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.