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 |
|---|---|---|---|---|
| Tc-99m pertechnetate per mci HCPCS A9512 | $99.30 | $99.30 | $39.31 – $99.30 | 43 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $335.80 | $335.80 | $132.94 – $335.80 | 43 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $221.60 | $221.60 | $87.73 – $221.60 | 43 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $2,988.10 | $2,988.10 | $1,182.99 – $2,988.10 | 43 |
| Tc-99m sulfur colloid HCPCS A9541 | $855.40 | $855.40 | $338.65 – $855.40 | 43 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $198.05 | $198.05 | $78.41 – $198.05 | 43 |
| Tc-99m tilmanocept diag HCPCS A9520 | $2,740.00 | $2,740.00 | $1,084.77 – $2,740.00 | 43 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $99.45 | $153.00 | $46.98 – $153.00 | 43 |
| T cells total count CPT 86359 | $91.65 | $141.00 | $36.98 – $141.00 | 43 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | $107,550.00 | $107,550.00 | $23,757.00 – $107,550.00 | 114 |
| Telehealth original site facility fee HCPCS Q3014 | $52.00 | $80.00 | $31.67 – $80.00 | 43 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | $5,015.55 | $5,015.55 | $1,137.00 – $5,015.55 | 114 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $10,501.70 | $10,501.70 | $4,157.62 – $10,501.70 | 43 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $23,582.35 | $23,582.35 | $8,597.00 – $23,273.85 | 114 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $6.90 | $6.90 | $2.73 – $6.90 | 43 |
| Test stress cardiovascular tracing only CPT 93017 | $765.05 | $1,177.00 | $465.97 – $1,177.00 | 43 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $22,937.05 | $22,937.05 | $9,080.78 – $22,937.05 | 43 |
| Theophylline therapeutic drug level CPT 80198 | $117.00 | $180.00 | $71.26 – $180.00 | 43 |
| Therapy activity per session >= 45 minutes HCPCS G0176 | $422.50 | $650.00 | $257.34 – $650.00 | 43 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $128.70 | $198.00 | $78.39 – $198.00 | 43 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $129.35 | $199.00 | $78.78 – $199.00 | 43 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $94.90 | $146.00 | $57.80 – $146.00 | 43 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $10.30 | $10.30 | $3.58 – $10.30 | 114 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $403.65 | $621.00 | $163.90 – $414.00 | 43 |
| Thiotepa 15 mg solution for injection HCPCS J9341 | $1,090.00 | $1,090.00 | $431.53 – $1,090.00 | 43 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,748.50 | $2,690.00 | $88.35 – $1,017.00 | 43 |
| Thrombin time CPT 85670 | $33.80 | $52.00 | $5.65 – $52.00 | 43 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $41.60 | $64.00 | $25.34 – $64.00 | 43 |
| Thyroglobulin antibody CPT 86800 | $122.20 | $188.00 | $74.43 – $188.00 | 43 |
| Thyroid (TSH) Test CPT 84443 | $124.80 | $192.00 | $76.01 – $192.00 | 43 |
| Thyroid Ultrasound CPT 76536 | $553.80 | $852.00 | $337.31 – $852.00 | 43 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | $10,828.50 | $10,828.50 | $2,113.24 – $10,828.50 | 114 |
| Thyroxine binding globulin (tbg) CPT 84442 | $82.55 | $127.00 | $50.28 – $127.00 | 43 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | $22,202.40 | $22,202.40 | $8,257.60 – $22,202.40 | 114 |
| Tissue amnio epifix inj 100mg HCPCS Q4145 | $2,428.40 | $3,736.00 | $727.47 – $1,837.50 | 43 |
| Tissue dermagraft 2x3in 37.5sqcm-cost per sq cm HCPCS Q4431 | $80.39 | $123.68 | $48.96 – $123.68 | 43 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $338.41 | $520.63 | $206.12 – $520.63 | 43 |
| Tissue matrix xcm thk 20x30cm -cost per sq cm HCPCS Q4142 | $58.21 | $89.56 | $35.46 – $89.56 | 43 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | $46.15 | $71.00 | $28.11 – $71.00 | 43 |
| Tissue transglutaminase iga CPT 86364 | $176.80 | $272.00 | $107.68 – $272.00 | 43 |
| Tl-201 thallium diag per mci HCPCS A9505 | $80.10 | $80.10 | $31.71 – $80.10 | 43 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $354.15 | $354.15 | $1.43 – $3.60 | 114 |
| Tobramycin peak therapeutic drug level CPT 80200 | $121.55 | $187.00 | $16.13 – $187.00 | 29 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $12,214.20 | $12,214.20 | $463.20 – $2,442.90 | 114 |
| Toe X-ray (both feet) CPT 73660 | $270.40 | $416.00 | $109.66 – $277.00 | 43 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $221.65 | $341.00 | $89.87 – $227.00 | 42 |
| Tomosynthesis breast screen bilateral CPT 77063 | $78.00 | $120.00 | $31.67 – $80.00 | 43 |
| Tonsillectomy (age 12+) CPT 42826 | $8,241.49 | not published | $0.96 – $4.55 | 72 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $188.75 | $188.75 | $45.53 – $115.00 | 43 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | $48,786.25 | $48,786.25 | $9,480.00 – $48,786.25 | 114 |
| Total Hip Replacement CPT 27130 | $28,335.83 | not published | $1.92 – $36.90 | 72 |
| Total Knee Replacement CPT 27447 | $22,449.86 | not published | $0.96 – $27.00 | 72 |
| Toxoplasma antibody igg CPT 86777 | $79.30 | $122.00 | $14.39 – $122.00 | 43 |
| Toxoplasma antibody igm CPT 86778 | $62.40 | $96.00 | $14.41 – $96.00 | 43 |
| Trabectedin 1 mg intravenous solution HCPCS J9352 | $11,842.80 | $11,842.80 | $4,192.10 – $11,842.80 | 114 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $164.00 | $242.00 | $17.73 – $242.00 | 779 |
| Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution HCPCS J3290 | $10.60 | $10.60 | $2.00 – $10.60 | 114 |
| Transferrin CPT 84466 | $109.85 | $169.00 | $66.91 – $169.00 | 43 |
| Transvaginal Pelvic Ultrasound (not pregnancy) CPT 76830 | $558.35 | $859.00 | $340.08 – $859.00 | 43 |
| Transvaginal Pregnancy Ultrasound CPT 76817 | $589.55 | $907.00 | $359.08 – $907.00 | 43 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | $4,708.00 | $4,708.00 | $1,250.55 – $4,675.30 | 114 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | $10,508.35 | $10,508.35 | $649.20 – $2,766.05 | 114 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | $9,357.40 | $9,357.40 | $429.30 – $3,365.30 | 114 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,798.25 | $4,305.00 | $1,363.48 – $3,444.00 | 43 |
| Tray bonemarrw oncontrol 102mm HCPCS C1830 | $871.32 | $1,340.50 | $19.32 – $48.80 | 43 |
| Tray trach basic clean/care ster HCPCS A4626 | $2.21 | $3.40 | $1.35 – $3.40 | 43 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $241.15 | $371.00 | $146.88 – $371.00 | 43 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $158.60 | $244.00 | $96.60 – $244.00 | 43 |
| Treatment of ankle fracture 27786 CPT 27786 | $2,409.55 | $3,707.00 | $978.27 – $2,471.00 | 43 |
| Treatment of mouth lesion physical 40820 CPT 40820 | $6,324.50 | $9,730.00 | $141.40 – $612.00 | 43 |
| Tremelimumab-actl 20 mg/ml intravenous solution HCPCS J9347 | $127,265.40 | $127,265.40 | $3,862.00 – $10,605.45 | 114 |
| Treponema pallidum antibody CPT 86780 | $130.00 | $200.00 | $79.18 – $200.00 | 43 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $39.90 | $52.53 | $0.65 – $39.10 | 779 |
| Triglycerides CPT 84478 | $50.05 | $77.00 | $5.63 – $77.00 | 43 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | $8,065.15 | $8,065.15 | $1,617.00 – $8,065.15 | 114 |
| Trim nondyst nails CPT 11719 | $115.70 | $178.00 | $6.42 – $60.00 | 43 |
| Troponin quantitative CPT 84484 | $763.75 | $192.00 | $9.09 – $192.00 | 43 |
| Tube drain vert dev st 5-40f HCPCS A5200 | $14.14 | $21.76 | $8.61 – $21.76 | 43 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $529.67 | $814.87 | $5.37 – $13.56 | 43 |
| Tube trach disp innr can 6 xlt HCPCS A4623 | $11.13 | $17.12 | $3.12 – $7.88 | 43 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | $133.09 | $204.75 | $1.74 – $4.40 | 43 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | $35,496.45 | $35,496.45 | $10,785.00 – $35,496.45 | 114 |
| Ultrasound breast complete CPT 76641 | $799.50 | $1,230.00 | $91.69 – $820.00 | 43 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $729.30 | $1,122.00 | $75.49 – $748.00 | 43 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $534.95 | $823.00 | $325.83 – $823.00 | 43 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $534.95 | $823.00 | $53.57 – $823.00 | 43 |
| Ultrasound hips infant dynamic CPT 76885 | $538.85 | $829.00 | $328.20 – $829.00 | 43 |
| Ultrasound joint complete left CPT 76881 | $642.85 | $989.00 | $391.55 – $989.00 | 43 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $446.55 | $687.00 | $271.98 – $687.00 | 43 |
| Unit mobile power mpu HCPCS Q0479 | $11,232.00 | $17,280.00 | $6,841.15 – $17,280.00 | 43 |
| Unlisted procedure microbiology CPT 87999 | $2,388.75 | $3,675.00 | $1,454.93 – $3,675.00 | 43 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $201.50 | $310.00 | $122.73 – $310.00 | 43 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,330.55 | $2,047.00 | $810.41 – $2,047.00 | 43 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $4,634.50 | $7,130.00 | $2,822.77 – $7,130.00 | 43 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,551.90 | $3,926.00 | $1,554.30 – $3,926.00 | 42 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $261.30 | $402.00 | $159.15 – $402.00 | 43 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $333.45 | $513.00 | $203.10 – $513.00 | 43 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $5,767.09 | $1,386.00 | $3.33 – $1,386.00 | 780 |
| Urea nitrogen CPT 84520 | $42.25 | $65.00 | $25.73 – $65.00 | 43 |
| Urea nitrogen 24 hour urine CPT 84540 | $54.60 | $84.00 | $33.26 – $84.00 | 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.