Mercy Medical Center - New Hampton
Mercy Medical Center - New Hampton in New Hampton, IA publishes cash prices for 52 common procedures listed here, from its own machine-readable price file updated Mar 31, 2026. Click a procedure to compare it with other hospitals nearby.
308 North Maple Ave, New Hampton, IA 50659 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $3,664.05 | $5,637.00 | 35% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $4,174.95 | — | — |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 HC CT Abdomen & Pelvis W/Contrast | $3,664.05 | $5,637.00 | 35% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head/Brain W/O Contrast | $1,368.25 | $2,105.00 | 35% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 HC CT Head/Brain W/O Contrast | $1,368.25 | $2,105.00 | 35% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis W/Contrast | $1,740.05 | $2,677.00 | 35% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis W/Contrast | $1,740.05 | $2,677.00 | 35% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammography Diagnostic Bilateral | $445.90 | $686.00 | 35% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammography Diagnostic Bilateral | $445.90 | $686.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $297.05 | $457.00 | 35% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $297.05 | $457.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Lt | $297.05 | $457.00 | 35% |
| Diagnostic mammogram, one breast inpatient one side CPT 77065 HC Mammography Diagnostic Unilateral Rt | $297.05 | $457.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,903.25 | $6,005.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $2,601.95 | $4,003.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $2,601.95 | $4,003.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Bl | $3,903.25 | $6,005.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Rt | $2,601.95 | $4,003.00 | 35% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient one side CPT 73721 HC MRI Lower Extremity Joint W/O Contrast Lt | $2,601.95 | $4,003.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $4,938.70 | $7,598.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $3,292.25 | $5,065.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $3,292.25 | $5,065.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Bl | $4,938.70 | $7,598.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Rt | $3,292.25 | $5,065.00 | 35% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient one side CPT 73723 HC MRI Lower Extremity Joint W/O & W/Contrast Lt | $3,292.25 | $5,065.00 | 35% |
| MRI of the brain, no contrast dye CPT 70551 HC MRI Brain W/O Contrast | $2,297.10 | $3,534.00 | 35% |
| MRI of the brain, no contrast dye inpatient CPT 70551 HC MRI Brain W/O Contrast | $2,297.10 | $3,534.00 | 35% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MRI Brain W/O & W/Contrast | $3,606.85 | $5,549.00 | 35% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 HC MRI Brain W/O & W/Contrast | $3,606.85 | $5,549.00 | 35% |
| MRI of the lower back, no contrast dye CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,598.70 | $3,998.00 | 35% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MRI Lumbar Spine W/O Contrast | $2,598.70 | $3,998.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $732.55 | $1,127.00 | 35% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 HC US Pregnant Uterus >= 14 Weeks Single/1st Gestation | $732.55 | $1,127.00 | 35% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammography Screen Bilateral | $461.50 | $710.00 | 35% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $307.45 | $473.00 | 35% |
| Screening mammogram, both breasts inpatient both sides CPT 77067 HC Mammography Screen Bilateral | $461.50 | $710.00 | 35% |
| Screening mammogram, both breasts inpatient one side CPT 77067 HC Mammography Screen Bl Reduced Service Unilateral Only Completed | $307.45 | $473.00 | 35% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,901.30 | $6,002.00 | 35% |
| Sleep study in a lab (polysomnography) inpatient CPT 95810 HC Polysomnography Sleep Staging >=4 Parameters Age >=6 Years | $3,901.30 | $6,002.00 | 35% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal Non Obstetric | $558.35 | $859.00 | 35% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal Non Obstetric | $558.35 | $859.00 | 35% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $692.90 | $1,066.00 | 35% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 HC US Abdomen Complete | $692.90 | $1,066.00 | 35% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $369.20 | $568.00 | 35% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 HC Xr Lumbosacral Spine >= 4 Views | $369.20 | $568.00 | 35% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $103.35 | $159.00 | 35% |
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $322.40 | — | — |
| Basic metabolic panel (blood test) inpatient CPT 80048 HC Basic Metabolic Panel (Calcium Total) | $103.35 | $159.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Mayo Lmpp Lipid Panel | $110.50 | $170.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $110.50 | $170.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Panel | $646.10 | — | — |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Lipid Panel | $110.50 | $170.00 | 35% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 HC Mayo Lmpp Lipid Panel | $110.50 | $170.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $72.80 | $112.00 | 35% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc Automated/Differential Wbc Automated | $607.75 | — | — |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc Automated/Differential Wbc Automated | $72.80 | $112.00 | 35% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc Automated | $56.55 | $87.00 | 35% |
| Complete blood count (CBC), no differential inpatient CPT 85027 HC Cbc Automated | $56.55 | $87.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $126.10 | $194.00 | 35% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $624.65 | — | — |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $126.10 | $194.00 | 35% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $94.25 | $145.00 | 35% |
| Kidney function blood test panel inpatient CPT 80069 HC Renal Function Panel | $94.25 | $145.00 | 35% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $110.50 | $170.00 | 35% |
| Liver function blood test panel inpatient CPT 80076 HC Hepatic Function Panel | $110.50 | $170.00 | 35% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Mayo Psaft Prostate Specific Antigen Free | $140.40 | $216.00 | 35% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 HC Mayo Psaft Prostate Specific Antigen Free | $140.40 | $216.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Prostate Specific Antigen Total | $122.20 | $188.00 | 35% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Mayo Psaft Prostate Specific Antigen Total | $122.20 | $188.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Prostate Specific Antigen Total | $122.20 | $188.00 | 35% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 HC Mayo Psaft Prostate Specific Antigen Total | $122.20 | $188.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Mayo Aathr Thromboplastin Time Partial (Ptt) | $64.35 | $99.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $64.35 | $99.00 | 35% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Thromboplastin Time Partial (Ptt) | $823.55 | — | — |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Mayo Aathr Thromboplastin Time Partial (Ptt) | $64.35 | $99.00 | 35% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 HC Thromboplastin Time Partial (Ptt) | $64.35 | $99.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PR Prothrombin Time | $9.00 | $9.00 | — |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $42.90 | $66.00 | 35% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Mayo Aathr Prothrombin Time | $42.90 | $66.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PR Prothrombin Time | $10.00 | — | — |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Prothrombin Time | $42.90 | $66.00 | 35% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 HC Mayo Aathr Prothrombin Time | $42.90 | $66.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Thyroid Stimulating Hormone | $124.80 | $192.00 | 35% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 HC Thyroid Stimulating Hormone | $124.80 | $192.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $44.20 | $68.00 | 35% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy Automated | $341.25 | — | — |
| Urinalysis with microscope exam, automated inpatient CPT 81001 HC Urinalysis With Microscopy Automated | $44.20 | $68.00 | 35% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urinalysis Without Microscopy Automated | $39.65 | $61.00 | 35% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Urinalysis Without Microscopy Automated | $39.65 | $61.00 | 35% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $551.00 | $551.00 | — |
| Colonoscopy with polyp removal CPT 45385 HC Colon Flex W/Rem Tumor(S)/Polyp(S)/Other Lesion(S) by Snare Tech (Restricted Method II CAH) | $1,086.80 | $1,672.00 | 35% |
| Colonoscopy with polyp removal CPT 45385 HC Colon Flex W/Rem Tumor(S)/Polyp(S)/Other Lesion(S) by Snare Tech (Restricted Method II CAH) | $5,248.00 | — | — |
| Colonoscopy with polyp removal inpatient CPT 45385 PR Colonoscopy Flexible With Removal Tumor/Polyp/Other Lesion by Snare Tech | $924.00 | $924.00 | — |
| Colonoscopy with polyp removal inpatient CPT 45385 HC Colon Flex W/Rem Tumor(S)/Polyp(S)/Other Lesion(S) by Snare Tech (Restricted Method II CAH) | $1,086.80 | $1,672.00 | 35% |
| Colonoscopy with tissue sample CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $730.00 | — | — |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $1,038.05 | $1,597.00 | 35% |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $6,809.27 | — | — |
| Colonoscopy with tissue sample inpatient CPT 45380 PR Colonoscopy Flexible With Biopsy Single/Multiple | $730.00 | $730.00 | — |
| Colonoscopy with tissue sample inpatient CPT 45380 HC Colonoscopy Flexible With Biopsy Single/Multiple (Restricted Method II CAH) | $1,038.05 | $1,597.00 | 35% |
| Colonoscopy, diagnostic CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $671.00 | — | — |
| Colonoscopy, diagnostic CPT 45378 HC Colon Flexible Dx W/Collection of Specimen(S) by Brushing/Washing (Restricted Method II CAH) | $3,480.68 | — | — |
| Colonoscopy, diagnostic inpatient CPT 45378 PR Colonoscopy Flexible Diagnostic W Collection Specimen Brushing/Washing | $671.00 | $671.00 | — |
| Knee arthroscopy with meniscus trim one side CPT 29881 HC Arthro Knee W/Mnsc Med or Lat Incl/Chndrplsty Same/Sep Compart Lt (Rest Method II CAH) | $9,979.22 | — | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $213.00 | $213.00 | — |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance(Rest Method II CAH) | $478.40 | $736.00 | 35% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,006.85 | $1,549.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 PR Injection(S) Epidural Lumbar Needle Placement W/Guidance | $310.00 | $310.00 | — |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance(Rest Method II CAH) | $478.40 | $736.00 | 35% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 HC Injection(S) Epidural/Subarachnoid Lumbar/Sacral Needle Placement W/Guidance | $1,006.85 | $1,549.00 | 35% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,736.15 | $2,671.00 | 35% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HC Injection(S) Epidural Lumbar Needle Placement W/O Guidance | $1,736.15 | $2,671.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $321.12 | — | — |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Bl | $6,399.90 | $9,846.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Lt | $4,266.60 | $6,564.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Rt | $4,266.60 | $6,564.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level | $347.00 | $347.00 | — |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Bl | $6,399.90 | $9,846.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Lt | $4,266.60 | $6,564.00 | 35% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient one side CPT 64483 HC Injection(S) Anesthetic Agent(S)/Steroid Lumb/S Transforaminal Epidural W/Img Single Rt | $4,266.60 | $6,564.00 | 35% |
| Total hip replacement one side CPT 27130 HC Arthoplasty Acetabular & Proximal Femoral Prosthetic Repl Rt (Restricted Method II CAH) | $28,335.83 | — | — |
| Total knee replacement one side CPT 27447 HC Arthro Knee/Condyle/Plateau Med/Lat W/or W/O Patella Resurf (Tka) Lt(Rest Method II CAH) | $22,449.86 | — | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $301.00 | $301.00 | — |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $900.90 | $1,386.00 | 35% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $5,767.09 | — | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 PR Egd Flexible Transoral W/ Biopsy Single/Multiple | $503.00 | $503.00 | — |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 HC Egd Flexible Transoral W/Bx Single/Mult (Restricted Method II CAH) | $900.90 | $1,386.00 | 35% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC Ecg 12 Lead With Interpretation & Report (Restricted Method II CAH) | $31.85 | $49.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 PR Ecg 12 Lead Interpretation & Report | $63.00 | $63.00 | — |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 HC Ecg 12 Lead Interpretation & Report | $81.25 | $125.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC Ecg 12 Lead With Interpretation & Report (Restricted Method II CAH) | $31.85 | $49.00 | 35% |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 PR Ecg 12 Lead Interpretation & Report | $49.00 | — | — |
| Electrocardiogram (ECG/EKG) with interpretation inpatient CPT 93000 HC Ecg 12 Lead Interpretation & Report | $81.25 | $125.00 | 35% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $302.90 | $466.00 | 35% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Psychotherapy Family W/Patient 50 Minutes | $302.90 | $466.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy | $501.80 | $772.00 | 35% |
| Group psychotherapy session CPT 90853 HC Psychotherapy Group Therapy Msw | $501.80 | $772.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy | $501.80 | $772.00 | 35% |
| Group psychotherapy session inpatient CPT 90853 HC Psychotherapy Group Therapy Msw | $501.80 | $772.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 HC Visit New Low Pro 30-44 Mins (Restricted Method II CAH) | $163.80 | $252.00 | 35% |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 30 minutes CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 30 minutes CPT 99203 HC Visit New Low Pro 30-44 Mins (Restricted Method II CAH) | $358.80 | — | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 HC Visit New Low Pro 30-44 Mins (Restricted Method II CAH) | $163.80 | $252.00 | 35% |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 30 minutes inpatient CPT 99203 PR Visit Office Outpatient New Low Level | $180.00 | $180.00 | — |
| New patient office visit, about 45 minutes CPT 99204 HC Visit New Mod Pro 45-59 Mins (Restricted Method II CAH) | $250.90 | $386.00 | 35% |
| New patient office visit, about 45 minutes CPT 99204 HC Visit New Mod Pro 45-59 Mins (Restricted Method II CAH) | $250.90 | — | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 45 minutes CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 HC Visit New Mod Pro 45-59 Mins (Restricted Method II CAH) | $250.90 | $386.00 | 35% |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 45 minutes inpatient CPT 99204 PR Visit Office Outpatient New Moderate Level | $307.00 | $307.00 | — |
| New patient office visit, about 60 minutes CPT 99205 HC Visit New High Pro 60-74 Mins (Restricted Method II CAH) | $317.20 | $488.00 | 35% |
| New patient office visit, about 60 minutes CPT 99205 PR Visit Office Outpatient New High Level | $402.00 | $402.00 | — |
| New patient office visit, about 60 minutes inpatient CPT 99205 HC Visit New High Pro 60-74 Mins (Restricted Method II CAH) | $317.20 | $488.00 | 35% |
| New patient office visit, about 60 minutes inpatient CPT 99205 PR Visit Office Outpatient New High Level | $388.00 | $388.00 | — |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $129.35 | $199.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $129.35 | $199.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Ot Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $129.35 | $199.00 | 35% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pt Therapeutic Procedure >=1 Area Therapeutic Exercise Each 15 Minutes | $129.35 | $199.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $195.65 | $301.00 | 35% |
| Preventive checkup, new patient aged 18–39 CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $237.00 | $237.00 | — |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 HC E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $195.65 | $301.00 | 35% |
| Preventive checkup, new patient aged 18–39 inpatient CPT 99385 PR E&M Preventive Medicine Initial Comprehensive New Patient 18-39 Years | $199.00 | $199.00 | — |
| Preventive checkup, new patient aged 40–64 CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $226.85 | $349.00 | 35% |
| Preventive checkup, new patient aged 40–64 CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $288.00 | $288.00 | — |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 HC E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $226.85 | $349.00 | 35% |
| Preventive checkup, new patient aged 40–64 inpatient CPT 99386 PR E&M Preventive Medicine Initial Comprehensive New Patient 40-64 Years | $241.00 | $241.00 | — |
| Psychotherapy session, 30 minutes CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $396.50 | $610.00 | 35% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Psychotherapy Patient Individual Therapy 30 Minutes | $396.50 | $610.00 | 35% |
| Psychotherapy session, 45 minutes CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $490.75 | $755.00 | 35% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Psychotherapy Patient Individual Therapy 45 Minutes | $490.75 | $755.00 | 35% |
| Psychotherapy session, 60 minutes CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $500.50 | $770.00 | 35% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Psychotherapy Patient Individual Therapy 60 Minutes | $500.50 | $770.00 | 35% |
Source file: https://hpt.trinity-health.org/311568151_mercy-medical-center-new-hampton_standardcharges.zip