▸ Hospital · IA · CCN 161333

Story County Hospital

630 6TH STREET, NEVADA, IA, 50201

17 bedsCritical Access Hospitals9

Compliance grade

86/100

Procedures tracked

116

of 209 target codes

Payers

with negotiated rates

Rates published

1,964

last crawl 2026-05-23

▸ Compare with other hospitals All IA hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://www.storymedical.org/filesimages/charge-masters/426037754_Story-County-Hospital_StandardCharges.csv · CSV

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychiatric diagnostic evaluation	CPT	90791	0	$232	$185.6	—	—	—
Psychiatric eval with medical services	CPT	90792	0	$322	$257.6	—	—	—
Psychotherapy 30 minutes	CPT	90832	0	$160	$128	—	—	—
Psychotherapy 45 minutes	CPT	90834	0	$176	$140.8	—	—	—
Psychotherapy 60 minutes	CPT	90837	0	$196	$156.8	—	—	—
emergency
ED visit level 1	CPT	99281	0	$253	$202.4	—	—	—
ED visit level 2	CPT	99282	0	$329	$263.2	—	—	—
ED visit level 3	CPT	99283	0	$517	$413.6	—	—	—
ED visit level 4	CPT	99284	0	$688	$550.4	—	—	—
ED visit level 5	CPT	99285	0	$1,010	$808	—	—	—
Critical care, first hour	CPT	99291	0	$1,356	$1,084.8	—	—	—
imaging
CT head without contrast	CPT	70450	0	$1,978	$1,582.4	—	—	—
CT head with contrast	CPT	70460	0	$2,171	$1,736.8	—	—	—
CT head with and without contrast	CPT	70470	0	$2,300	$1,840	—	—	—
CT neck with contrast	CPT	70491	0	$2,249	$1,799.2	—	—	—
MRI brain without contrast	CPT	70551	0	$3,208	$2,566.4	—	—	—
MRI brain with contrast	CPT	70552	0	$3,319	$2,655.2	—	—	—
MRI brain with and without contrast	CPT	70553	0	$3,783	$3,026.4	—	—	—
Chest X-ray single view	CPT	71045	0	$265	$212	—	—	—
Chest X-ray 2 views	CPT	71046	0	$301	$240.8	—	—	—
CT chest without contrast	CPT	71250	0	$2,035	$1,628	—	—	—
CT chest with contrast	CPT	71260	0	$2,149	$1,719.2	—	—	—
CT chest with and without contrast	CPT	71270	0	$2,375	$1,900	—	—	—
MRI chest without contrast	CPT	71550	0	$3,414	$2,731.2	—	—	—
MRI chest with and without contrast	CPT	71552	0	$4,083	$3,266.4	—	—	—
Lumbosacral spine X-ray	CPT	72100	0	$301	$240.8	—	—	—
CT cervical spine without contrast	CPT	72125	0	$2,035	$1,628	—	—	—
CT thoracic spine without contrast	CPT	72128	0	$2,035	$1,628	—	—	—
CT lumbar spine without contrast	CPT	72131	0	$2,035	$1,628	—	—	—
MRI cervical spine without contrast	CPT	72141	0	$3,337	$2,669.6	—	—	—
MRI thoracic spine without contrast	CPT	72146	0	$3,550	$2,840	—	—	—
MRI lumbar spine without contrast	CPT	72148	0	$3,614	$2,891.2	—	—	—
MRI lumbar spine with and without contrast	CPT	72149	0	$3,864	$3,091.2	—	—	—
MRI cervical spine with and without contrast	CPT	72156	0	$3,763	$3,010.4	—	—	—
MRI lumbar spine with contrast	CPT	72158	0	$4,054	$3,243.2	—	—	—
CT pelvis without contrast	CPT	72192	0	$2,143	$1,714.4	—	—	—
CT pelvis with contrast	CPT	72193	0	$2,369	$1,895.2	—	—	—
Shoulder X-ray	CPT	73030	0	$272	$217.6	—	—	—
Humerus X-ray	CPT	73060	0	$209	$167.2	—	—	—
Hand X-ray 3 views	CPT	73130	0	$288	$230.4	—	—	—
MRI upper extremity joint without contrast	CPT	73221	0	$3,215	$2,572	—	—	—
MRI upper extremity joint with and without contrast	CPT	73223	0	$3,444	$2,755.2	—	—	—
Knee X-ray 1-2 views	CPT	73560	0	$253	$202.4	—	—	—
Ankle X-ray 3 views	CPT	73610	0	$280	$224	—	—	—
MRI lower extremity joint without contrast	CPT	73721	0	$1,859	$1,487.2	—	—	—
MRI lower extremity joint with and without contrast	CPT	73723	0	$3,754	$3,003.2	—	—	—
CT abdomen without contrast	CPT	74150	0	$2,143	$1,714.4	—	—	—
CT abdomen with contrast	CPT	74160	0	$2,369	$1,895.2	—	—	—
CT abdomen with and without contrast	CPT	74170	0	$2,441	$1,952.8	—	—	—
CT abdomen and pelvis without contrast	CPT	74176	0	$4,282	$3,425.6	—	—	—
CT abdomen and pelvis with contrast	CPT	74177	0	$4,730	$3,784	—	—	—
CT abdomen and pelvis with and without contrast	CPT	74178	0	$4,886	$3,908.8	—	—	—
MRI abdomen without contrast	CPT	74181	0	$3,124	$2,499.2	—	—	—
MRI abdomen with and without contrast	CPT	74183	0	$3,342	$2,673.6	—	—	—
Abdominal ultrasound complete	CPT	76700	0	$1,196	$956.8	—	—	—
Abdominal ultrasound limited	CPT	76705	0	$820	$656	—	—	—
Retroperitoneal ultrasound complete	CPT	76770	0	$883	$706.4	—	—	—
Obstetric ultrasound first trimester	CPT	76801	0	$721	$576.8	—	—	—
Obstetric ultrasound after first trimester	CPT	76805	0	$721	$576.8	—	—	—
Transvaginal ultrasound	CPT	76830	0	$1,083	$866.4	—	—	—
Pelvic ultrasound complete	CPT	76856	0	$1,112	$889.6	—	—	—
Scrotal ultrasound	CPT	76870	0	$777	$621.6	—	—	—
EKG tracing only	CPT	93005	0	$119	$95.2	—	—	—
EKG interpretation only	CPT	93010	0	$90	$72	—	—	—
Transthoracic echocardiogram complete	CPT	93306	0	$2,753	$2,202.4	—	—	—
Stress echocardiogram	CPT	93350	0	$1,588	$1,270.4	—	—	—
inpatient
Initial hospital care, low complexity	CPT	99221	0	$451	$360.8	—	—	—
Initial hospital care, moderate complexity	CPT	99222	0	$606	$484.8	—	—	—
Initial hospital care, high complexity	CPT	99223	0	$898	$718.4	—	—	—
Hospital discharge, <30 min	CPT	99238	0	$219	$175.2	—	—	—
Hospital discharge, >30 min	CPT	99239	0	$315	$252	—	—	—
lab
Basic metabolic panel (BMP)	CPT	80048	0	$34	$27.2	—	—	—
General health panel	CPT	80050	0	$26	$20.8	—	—	—
Electrolyte panel	CPT	80051	0	$29	$23.2	—	—	—
Comprehensive metabolic panel	CPT	80053	0	$42	$33.6	—	—	—
Lipid panel	CPT	80061	0	$55	$44	—	—	—
Renal function panel	CPT	80069	0	$124	$99.2	—	—	—
Hepatic function panel	CPT	80076	0	$33	$26.4	—	—	—
Urinalysis non-automated	CPT	81002	0	$20	$16	—	—	—
Urinalysis automated	CPT	81003	0	$11	$8.8	—	—	—
Glucose quantitative	CPT	82947	0	$89	$71.2	—	—	—
Hemoglobin A1c	CPT	83036	0	$40	$32	—	—	—
Thyroid stimulating hormone (TSH)	CPT	84443	0	$376	$300.8	—	—	—
Complete blood count with automated differential	CPT	85025	0	$32	$25.6	—	—	—
Complete blood count without differential	CPT	85027	0	$27	$21.6	—	—	—
Urine culture bacterial	CPT	87086	0	$19	$15.2	—	—	—
Urine culture identification	CPT	87088	0	$19	$15.2	—	—	—
Tissue exam by pathologist level IV	CPT	88305	0	$301	$240.8	—	—	—
maternity
Fetal non-stress test	CPT	59025	0	$61	$48.8	—	—	—
office
Office visit, new patient, 15-29 min	CPT	99202	0	$328	$262.4	—	—	—
Office visit, new patient, 30-44 minutes	CPT	99203	0	$461	$368.8	—	—	—
Office visit, new patient, 45-59 min	CPT	99204	0	$718	$574.4	—	—	—
Office visit, new patient, 60-74 min	CPT	99205	0	$880	$704	—	—	—
Office visit, established patient, 5 min	CPT	99211	0	$105	$84	—	—	—
Office visit, established patient, 10-19 min	CPT	99212	0	$190	$152	—	—	—
Office visit, established patient, 20-29 minutes	CPT	99213	0	$320	$256	—	—	—
Office visit, established patient, 30-39 minutes	CPT	99214	0	$503	$402.4	—	—	—
Office visit, established patient, 40-54 min	CPT	99215	0	$668	$534.4	—	—	—
preventive
Upper GI endoscopy diagnostic	CPT	43235	0	$353	$282.4	—	—	—
Upper GI endoscopy with biopsy	CPT	43239	0	$953	$762.4	—	—	—
Sigmoidoscopy diagnostic	CPT	45330	0	$544	$435.2	—	—	—
Colonoscopy diagnostic	CPT	45378	0	$989	$791.2	—	—	—
Colonoscopy with biopsy	CPT	45380	0	$1,260	$1,008	—	—	—
Colonoscopy with polyp removal	CPT	45385	0	$1,584	$1,267.2	—	—	—
surgery
Total shoulder arthroplasty	CPT	23472	0	$3,987	$3,189.6	—	—	—
Total hip replacement	CPT	27130	0	$5,712	$4,569.6	—	—	—
Total knee replacement	CPT	27447	0	$5,712	$4,569.6	—	—	—
Knee revision arthroplasty all components	CPT	27487	0	$6,523	$5,218.4	—	—	—
Shoulder arthroscopy with decompression	CPT	29826	0	$678	$542.4	—	—	—
Shoulder arthroscopy with rotator cuff repair	CPT	29827	0	$3,976	$3,180.8	—	—	—
Knee arthroscopy with meniscectomy	CPT	29881	0	$1,945	$1,556	—	—	—
ACL reconstruction	CPT	29888	0	$3,734	$2,987.2	—	—	—
Laparoscopic cholecystectomy	CPT	47562	0	$3,161	$2,528.8	—	—	—
Vaginal hysterectomy	CPT	58260	0	$2,801	$2,240.8	—	—	—
Lap-assisted vaginal hysterectomy >250g	CPT	58552	0	$3,427	$2,741.6	—	—	—
Lap salpingo-oophorectomy	CPT	58661	0	$1,592	$1,273.6	—	—	—