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 |
|---|---|---|---|---|
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $19.00 | $19.00 | $1.72 – $4.35 | 43 |
| Gentamicin peak therapeutic drug level CPT 80170 | $97.50 | $150.00 | $59.39 – $150.00 | 43 |
| Ghs abscess perianal iandd CPT 46050 | $1,672.00 | $1,672.00 | $16.12 – $1,469.00 | 780 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $925.00 | $1,200.00 | $34.12 – $1,200.00 | 780 |
| Ghs clsd tx frac distal tibia w/manipulation CPT 27825 | $1,808.95 | $2,783.00 | $433.41 – $1,855.00 | 43 |
| Ghs excision ingrown nail CPT 11765 | $461.87 | $385.00 | $12.06 – $385.00 | 768 |
| Ghs fb removal - non-incisional CPT 20520 | $616.00 | $616.00 | $45.27 – $372.00 | 768 |
| Ghs flow volume loop CPT 94375 | $197.60 | $304.00 | $120.35 – $304.00 | 43 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $344.00 | $344.00 | $18.43 – $235.00 | 768 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $395.85 | $609.00 | $241.10 – $609.00 | 43 |
| Ghs inj neurolytic other perph nerve CPT 64640 | $2,363.40 | $3,636.00 | $103.75 – $780.00 | 43 |
| Ghs inj tendon origin/insertion CPT 20551 | $519.35 | $799.00 | $10.55 – $799.00 | 780 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $650.00 | $1,000.00 | $395.90 – $1,000.00 | 43 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $710.00 | $710.00 | $59.64 – $665.70 | 768 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $719.55 | $1,107.00 | $166.21 – $1,107.00 | 43 |
| Ghs musc test done w/n test comp CPT 95886 | $356.20 | $548.00 | $144.50 – $365.00 | 43 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $290.55 | $447.00 | $117.98 – $298.00 | 43 |
| Ghs nerve block axillary nerve CPT 64417 | $900.90 | $1,386.00 | $365.81 – $924.00 | 43 |
| Ghs nerve block interscaline CPT 64510 | $2,604.55 | $4,007.00 | $20.67 – $2,671.00 | 780 |
| Ghs nerve block suprascapular CPT 64418 | $883.35 | $1,359.00 | $358.69 – $906.00 | 43 |
| Ghs o2 saturation CPT 82810 | $76.70 | $118.00 | $46.72 – $118.00 | 43 |
| Ghs ppd (tb intradermal) CPT 86580 | $30.00 | $38.00 | $6.59 – $38.00 | 780 |
| Ghs removal intranasal foreign body CPT 30300 | $514.03 | $399.00 | $22.24 – $399.00 | 768 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $786.00 | $786.00 | $49.21 – $497.00 | 768 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $389.00 | $434.00 | $23.01 – $434.00 | 780 |
| Ghs urine, porphyrins quant CPT 84120 | $111.80 | $172.00 | $14.42 – $172.00 | 43 |
| Glove finger flexion right lg xl HCPCS L3912 | $62.95 | $96.84 | $27.48 – $69.40 | 43 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $655.40 | $655.40 | $259.47 – $655.40 | 42 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $567.40 | $567.40 | $224.63 – $567.40 | 43 |
| Glucose 1 hr post dose CPT 82950 | $41.60 | $64.00 | $25.34 – $64.00 | 43 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $27.30 | $42.00 | $2.30 – $42.00 | 780 |
| Glucose blood quantitative CPT 82947 | $36.40 | $56.00 | $22.17 – $56.00 | 43 |
| Glucose body fluid CPT 82945 | $45.50 | $70.00 | $3.89 – $70.00 | 43 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $157.30 | $242.00 | $95.81 – $242.00 | 43 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $92.30 | $142.00 | $56.22 – $142.00 | 43 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $53.95 | $83.00 | $32.86 – $83.00 | 43 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $3.15 | $3.15 | $1.25 – $3.15 | 43 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $5,516.60 | $5,516.60 | $551.50 – $5,516.60 | 114 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $133.25 | $205.00 | $81.16 – $205.00 | 43 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $135.20 | $208.00 | $82.35 – $208.00 | 43 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $16,064.55 | $16,064.55 | $803.41 – $5,895.10 | 114 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $117.42 | $180.64 | $71.52 – $180.64 | 43 |
| Graft axiofill 1000mg HCPCS J3590 | $5,986.50 | $9,210.00 | $570.10 – $1,440.00 | 43 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | $5.64 | $8.68 | $3.44 – $8.68 | 43 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $1,342.25 | $2,065.00 | $45.24 – $114.28 | 43 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $4,722.90 | $7,266.00 | $0.73 – $1.84 | 43 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $1,378.00 | $2,120.00 | $839.31 – $2,120.00 | 43 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $18,031.65 | $27,741.00 | $0.68 – $1.72 | 43 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $41,600.00 | $64,000.00 | $0.02 – $0.04 | 43 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $379.20 | $583.38 | $2.47 – $6.24 | 43 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $495.11 | $761.71 | $98.15 – $247.91 | 43 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $515.72 | $793.42 | $125.78 – $317.70 | 43 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $593.87 | $913.64 | $38.26 – $96.64 | 43 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | $68.90 | $106.00 | $41.97 – $106.00 | 43 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $1,517.49 | $2,334.60 | $0.08 – $0.20 | 43 |
| Graft viashield 2layer amnion patch 2x2cm-cost per sq cm HCPCS Q4211 | $739.37 | $1,137.50 | $172.60 – $435.96 | 43 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $388.64 | $597.91 | $19.67 – $49.68 | 43 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $29,676.26 | $45,655.78 | $15.84 – $40.00 | 43 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $19,865.30 | $30,562.00 | $51.39 – $129.80 | 43 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $2,420.79 | $3,724.30 | $1,463.70 – $3,697.14 | 43 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $4,680.16 | $7,200.24 | $0.02 – $0.04 | 43 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $931.61 | $1,433.25 | $0.02 – $0.04 | 43 |
| Gw stiffened micro access kit HCPCS C1894 | $9,340.50 | $14,370.00 | $0.02 – $0.04 | 43 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $31.05 | $31.05 | $12.29 – $31.05 | 43 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $3.65 | $3.65 | $1.45 – $3.65 | 43 |
| Handpiece aquabeam hp2000 HCPCS C2596 | $14,134.25 | $21,745.00 | $2,777.06 – $7,014.54 | 43 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $128.70 | $198.00 | $78.39 – $198.00 | 43 |
| Hand X-ray CPT 73130 | $305.50 | $470.00 | $9.50 – $26.72 | 43 |
| Haptoglobin quantitative CPT 83010 | $126.10 | $194.00 | $12.58 – $194.00 | 43 |
| Hcg qualitative CPT 84703 | $85.15 | $131.00 | $51.86 – $131.00 | 43 |
| Hcg quantitative CPT 84702 | $109.20 | $168.00 | $15.05 – $168.00 | 43 |
| Head CT scan (with and without contrast) CPT 70470 | $1,747.20 | $2,688.00 | $1,064.18 – $2,688.00 | 43 |
| Head CT scan (without contrast) CPT 70450 | $1,368.25 | $2,105.00 | $833.37 – $2,105.00 | 43 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $274.95 | $423.00 | $111.64 – $282.00 | 43 |
| Helicobacter pylori antibody igm CPT 86677 | $79.95 | $123.00 | $48.70 – $123.00 | 43 |
| Hematocrit CPT 85014 | $30.55 | $47.00 | $18.61 – $47.00 | 43 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $34,281.50 | $34,281.50 | $11,959.50 – $34,281.50 | 114 |
| Hemoglobin CPT 85018 | $25.35 | $39.00 | $1.84 – $39.00 | 780 |
| Hemoglobin fetal qualitative CPT 83033 | $128.70 | $198.00 | $78.39 – $198.00 | 43 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $74.75 | $115.00 | $8.20 – $115.00 | 29 |
| Hemoglobin plasma CPT 83051 | $83.85 | $129.00 | $7.16 – $129.00 | 43 |
| Heparin assay CPT 85520 | $53.95 | $83.00 | $32.86 – $83.00 | 43 |
| Heparin bolus from bag HCPCS J1644 | $45.00 | $45.00 | $5.50 – $19.15 | 113 |
| Heparin neutralization CPT 85525 | $47.45 | $73.00 | $28.90 – $73.00 | 43 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $3.00 | $3.00 | $1.19 – $3.00 | 43 |
| Hepatitis a antibody igm CPT 86709 | $100.10 | $154.00 | $60.97 – $154.00 | 43 |
| Hepatitis b core antibody igm CPT 86705 | $118.95 | $183.00 | $11.77 – $183.00 | 43 |
| Hepatitis b core antibody total CPT 86704 | $96.20 | $148.00 | $58.59 – $148.00 | 43 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $3,148.75 | $3,148.75 | $653.30 – $3,148.75 | 114 |
| Hepatitis b surface antibody CPT 86706 | $107.90 | $166.00 | $65.72 – $166.00 | 43 |
| Hepatitis c antibody CPT 86803 | $126.75 | $195.00 | $13.98 – $195.00 | 43 |
| Herpes simplex type 1 antibody igg CPT 86695 | $85.80 | $132.00 | $52.26 – $132.00 | 43 |
| Herpes simplex type 2 antibody igg CPT 86696 | $57.85 | $89.00 | $35.24 – $89.00 | 43 |
| Heterophile antibodies screening CPT 86308 | $52.00 | $80.00 | $31.67 – $80.00 | 43 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $312.65 | $481.00 | $190.43 – $481.00 | 43 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $306.80 | $472.00 | $186.86 – $472.00 | 43 |
| Hip X-ray CPT 73502 | $222.30 | $342.00 | $135.40 – $342.00 | 43 |
| Hldr trach tb tie ad HCPCS A7526 | $940.87 | $1,447.50 | $0.93 – $2.36 | 43 |
| Holder tube cath-secure nonstrl lf disp HCPCS A4333 | $3.12 | $4.80 | $1.90 – $4.80 | 43 |
| Home health re-certification physician g0179 HCPCS G0179 | $123.00 | $138.00 | $29.74 – $138.00 | 779 |
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.