| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Chi Health Missouri Valley | 809 Elm St, Missouri Valley | G0109 | $30 [source] | 4 years ago |
| Chi Health Mercy Corning | 601 Rosary Dr, Corning | G0109 | $30 [source] | 4 years ago |
| Chi Health Mercy | 1409 Clark St, Des Moines | G0109 | $55 [source] | 4 years ago |
| Osceola Regional Health Center | 600 9Th Ave N, Sibley | G0109 | $246 [source] | 4 years ago |