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 |
|---|---|---|---|---|
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $12,573.08 | $7,542.00 | $0.96 – $730.00 | 780 |
| Developmental screen/score/document 96110 CPT 96110 | $122.00 | $122.00 | $5.55 – $110.00 | 567 |
| Device ablt adv novasure HCPCS C1886 | $5,926.35 | $9,117.46 | $214.78 – $542.50 | 43 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $2,470.00 | $3,800.00 | $978.95 – $2,472.72 | 43 |
| Device intraute mirena HCPCS J7298 | $6,362.20 | $6,362.20 | $912.89 – $6,362.20 | 555 |
| Device sut capio slim opn HCPCS C2631 | $1,365.00 | $2,100.00 | $522.39 – $1,319.50 | 43 |
| Device tiss remov myosure reach HCPCS C1782 | $3,764.08 | $5,790.90 | $503.39 – $1,271.50 | 43 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $172.25 | $265.00 | $104.91 – $265.00 | 43 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $13.00 | $13.00 | $0.32 – $1.00 | 114 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $20.20 | $27.39 | $0.09 – $3.95 | 779 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $884.80 | $884.80 | $32.09 – $344.95 | 114 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $20.00 | $20.00 | $7.92 – $20.00 | 43 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $35.00 | $35.00 | $13.86 – $35.00 | 43 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $35.00 | $35.00 | $13.86 – $35.00 | 43 |
| Dextrose 5 % IV bolus HCPCS J7070 | $30.00 | $30.00 | $6.93 – $17.50 | 43 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $185.90 | $286.00 | $113.23 – $286.00 | 43 |
| Diabetes (HbA1c) Test CPT 83036 | $547.30 | $122.00 | $9.09 – $122.00 | 43 |
| Diab manage trn ind/group HCPCS G0109 | $79.30 | $122.00 | $48.30 – $122.00 | 43 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $209.30 | $322.00 | $127.48 – $322.00 | 43 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $445.90 | $686.00 | $142.21 – $686.00 | 43 |
| Diagnostic Mammogram (one breast) CPT 77065 | $297.05 | $457.00 | $112.74 – $457.00 | 43 |
| Diathermy eg microwave CPT 97024 | $65.65 | $101.00 | $39.99 – $101.00 | 43 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $250.05 | $250.05 | $68.31 – $172.55 | 43 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $25.30 | $25.30 | $1.25 – $4.00 | 114 |
| Digoxin total therapeutic drug level CPT 80162 | $91.65 | $141.00 | $13.01 – $141.00 | 43 |
| Dilator fascial 10fx20cm HCPCS C2627 | $342.50 | $526.93 | $14.65 – $37.00 | 43 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $41.90 | $41.90 | $0.20 – $3.00 | 114 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $3.70 | $3.70 | $0.90 – $3.70 | 114 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | $139.75 | $215.00 | $85.12 – $215.00 | 42 |
| Dna antibody native/double stranded CPT 86225 | $101.40 | $156.00 | $13.74 – $156.00 | 43 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $103.75 | $103.75 | $7.98 – $103.75 | 114 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $2,567.60 | $2,567.60 | $8.20 – $134.65 | 114 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $65.00 | $65.00 | $6.60 – $35.90 | 114 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $588.25 | $905.00 | $358.29 – $905.00 | 43 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $444.60 | $684.00 | $270.80 – $684.00 | 43 |
| Dornhoffer fixed part w/window HCPCS L8614 | $24,000.60 | $36,924.00 | $676.50 – $1,708.77 | 43 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | $36,812.65 | $36,812.65 | $13,341.50 – $36,812.65 | 114 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | $1,578.20 | $1,578.20 | $5.96 – $93.40 | 114 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | $7,093.75 | $7,093.75 | $760.50 – $1,920.95 | 43 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $28.30 | $28.30 | $11.20 – $28.30 | 114 |
| Drain blood from under nail 11740 CPT 11740 | $133.00 | $148.00 | $10.01 – $148.00 | 780 |
| Drain chst dry seal exp thorastat HCPCS A7041 | $143.78 | $221.20 | $87.57 – $221.20 | 43 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | $870.15 | $1,338.70 | $43.52 – $109.92 | 43 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $3,635.67 | $5,593.34 | $335.98 – $848.65 | 43 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $162.87 | $250.57 | $99.20 – $250.57 | 43 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $27.87 | $42.88 | $13.82 – $34.92 | 43 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $33.44 | $51.44 | $19.18 – $48.44 | 43 |
| Drsg sht 5.625x4.625in std HCPCS A6025 | $95.08 | $146.28 | $50.06 – $126.44 | 43 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | $1.90 | $2.92 | $1.16 – $2.92 | 43 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | $112.68 | $173.36 | $52.70 – $133.12 | 43 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | $55.69 | $85.68 | $14.76 – $37.28 | 43 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $5,917.86 | $9,104.40 | $34.92 – $88.20 | 43 |
| Drsg wound/burn 18x10cm suprathel resorb cost per sq cm HCPCS A2012 | $13.39 | $20.60 | $6.19 – $15.64 | 43 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | $308.74 | $474.99 | $82.05 – $207.24 | 43 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $137.15 | $211.00 | $83.53 – $211.00 | 43 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $7,528.59 | $6,407.00 | $0.96 – $413.00 | 780 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $1,101.10 | $1,694.00 | $670.65 – $1,694.00 | 43 |
| Duragen 1x1 5ea/bx HCPCS C9354 | $1,337.70 | $2,058.00 | $300.33 – $758.59 | 43 |
| Dura-guard dura repair patch 10x16cm -q4432-cost per sq cm-160sq cm HCPCS Q4432 | $178.45 | $274.54 | $8.63 – $21.80 | 43 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $13,206.10 | $13,206.10 | $1,119.48 – $3,169.50 | 114 |
| Ear irrigation 69209 CPT 69209 | $464.10 | $156.00 | $4.65 – $104.00 | 779 |
| Ecg/1-3 leads/interp & report only 93042 CPT 93042 | $14.30 | $22.00 | $6.67 – $22.00 | 43 |
| Ecg < 30 days transmission & analysis CPT 93271 | $477.75 | $735.00 | $290.99 – $735.00 | 43 |
| Ecg external < 48 hours recording CPT 93225 | $451.10 | $694.00 | $274.75 – $694.00 | 43 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $500.50 | $770.00 | $304.84 – $770.00 | 43 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $219.70 | $338.00 | $133.81 – $338.00 | 43 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $458.25 | $705.00 | $279.11 – $705.00 | 43 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,527.50 | $2,350.00 | $930.37 – $2,350.00 | 43 |
| Echocardiogram (Limited Follow-Up Heart Ultrasound) CPT 93308 | $910.00 | $1,400.00 | $554.26 – $1,400.00 | 43 |
| Echocardiography doppler color flow mapping CPT 93325 | $341.25 | $525.00 | $207.85 – $525.00 | 43 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $1,943.50 | $2,990.00 | $1,183.74 – $2,990.00 | 43 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $696.15 | $1,071.00 | $424.01 – $1,071.00 | 43 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $292.50 | $450.00 | $178.16 – $450.00 | 43 |
| Eculizumab 300 mg/30 ml intravenous solution HCPCS J1299 | $18,199.20 | $18,199.20 | $6,715.50 – $18,199.20 | 114 |
| Efgartigimod alfa-fcab 20 mg/ml intravenous solution HCPCS J9332 | $18,942.60 | $18,942.60 | $7,090.00 – $18,942.60 | 114 |
| EKG (Electrocardiogram) CPT 93000 | $81.25 | $125.00 | $10.72 – $50.95 | 779 |
| EKG tracing for initial prev HCPCS G0404 | $62.40 | $96.00 | $38.01 – $96.00 | 43 |
| EKG (Tracing Only) CPT 93005 | $945.10 | $245.00 | $5.46 – $24.00 | 43 |
| Elbow X-ray (2 views, both sides) CPT 73070 | $237.25 | $365.00 | $96.20 – $243.00 | 43 |
| Elbow X-ray (3 or more views, both sides) CPT 73080 | $327.60 | $504.00 | $133.02 – $336.00 | 43 |
| Electrd sq emblem s-icd HCPCS C1896 | $7,007.00 | $10,780.00 | $843.55 – $2,130.72 | 43 |
| Electrical Stimulation Therapy (each 15 minutes) CPT 97032 | $81.25 | $125.00 | $49.49 – $125.00 | 43 |
| Electrolyte panel CPT 80051 | $63.05 | $97.00 | $7.01 – $97.00 | 43 |
| Elotuzumab 300 mg intravenous solution HCPCS J9176 | $9,470.30 | $9,470.30 | $2,586.00 – $7,102.80 | 114 |
| Elranatamab-bcmm 40 mg/ml subcutaneous solution HCPCS J1323 | $42,858.30 | $42,858.30 | $14,083.56 – $42,858.30 | 114 |
| Emg 2 ext w-w/o paraspinal area 95861 CPT 95861 | $321.10 | $494.00 | $195.57 – $494.00 | 43 |
| Enfortumab vedotin-ejfv 20 mg intravenous solution HCPCS J9177 | $12,640.50 | $12,640.50 | $3,209.60 – $8,427.00 | 114 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $37.65 | $37.65 | $3.17 – $8.00 | 43 |
| Epcoritamab-bysp 48 mg/0.8 ml subcutaneous solution HCPCS J9321 | $50,429.90 | $50,429.90 | $1,522.75 – $4,202.50 | 114 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $410.00 | $410.00 | $27.90 – $161.62 | 768 |
| Epinephrine 0.1 mg/ml injection syringe HCPCS J0168 | $58.00 | $58.00 | $22.96 – $58.00 | 43 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $50.40 | $50.40 | $13.20 – $36.80 | 114 |
| Epinephrine 1 mg/ml im kit - pediatric HCPCS J0165 | $50.40 | $50.40 | $5.80 – $50.40 | 114 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $190.90 | $190.90 | $13.94 – $35.20 | 43 |
| Epirubicin 200 mg/100 ml intravenous solution HCPCS J9178 | $1,405.00 | $1,405.00 | $43.50 – $221.25 | 114 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $2,079.00 | $2,079.00 | $15.14 – $104.00 | 114 |
| Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr HCPCS J0885 | $4,916.35 | $4,916.35 | $9.09 – $152.50 | 114 |
| Epstein barr early antigen antibody CPT 86663 | $94.25 | $145.00 | $57.41 – $145.00 | 43 |
| Epstein barr nuclear antigen antibody CPT 86664 | $107.90 | $166.00 | $65.72 – $166.00 | 43 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $120.90 | $186.00 | $73.64 – $186.00 | 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.