MercyOne Genesis Davenport West Medical Center
1404 West Central Park Avenue, Davenport, IA · MercyOne · · NPI 1427097716
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 |
|---|---|---|---|---|
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $27.60 | $46.00 | not published | 0 |
| Ghs peritonsillar abscess i andd CPT 42700 | $373.80 | $623.00 | $222.29 – $311.20 | 2 |
| Ghs phenylketonurid CPT 84030 | $108.00 | $180.00 | $5.50 – $5.50 | 1 |
| Ghs picc line insert < 5 CPT 36568 | $794.40 | $1,324.00 | $860.60 – $1,486.98 | 2 |
| Ghs plngl fx pm cl CPT 26725 | $606.00 | $1,010.00 | $207.35 – $229.62 | 2 |
| Ghs plt ct-manual CPT 85032 | $34.80 | $58.00 | $4.31 – $4.31 | 1 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $2,840.40 | $4,734.00 | $973.87 – $1,363.41 | 2 |
| Ghs pos nystagmus CPT 92542 | $141.00 | $235.00 | $123.39 – $152.75 | 2 |
| Ghs ppd (tb intradermal) CPT 86580 | $28.80 | $48.00 | $23.44 – $30.55 | 2 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $92.40 | $154.00 | $9.66 – $9.66 | 1 |
| Ghs protein, misc fluid CPT 84160 | $28.20 | $47.00 | $5.61 – $5.61 | 1 |
| Ghs protoporphyrins fract CPT 84202 | $85.20 | $142.00 | $14.35 – $14.35 | 1 |
| Ghs pr without cont pulse ox CPT 94625 | $106.80 | $178.00 | $56.86 – $79.60 | 2 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $72.00 | $120.00 | $12.25 – $12.25 | 1 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $129.60 | $216.00 | not published | 0 |
| Ghs quinidine CPT 80194 | $118.20 | $197.00 | $14.60 – $14.60 | 1 |
| Ghs refill of implantable pump CPT 95990 | $237.00 | $395.00 | $256.75 – $317.50 | 2 |
| Ghs removal intranasal foreign body CPT 30300 | $424.80 | $708.00 | $123.39 – $161.85 | 2 |
| Ghs removal pharyngeal foreign body CPT 42809 | $320.40 | $534.00 | $161.85 – $381.97 | 2 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $1,011.60 | $1,686.00 | $538.85 – $1,531.94 | 2 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $1,093.80 | $1,823.00 | $205.40 – $3,105.81 | 2 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $174.00 | $290.00 | $15.89 – $15.89 | 1 |
| Ghs reticulocyte count CPT 85044 | $37.80 | $63.00 | $4.31 – $4.31 | 1 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $143.40 | $239.00 | $13.91 – $13.91 | 1 |
| Ghs sedimentation rate CPT 85651 | $24.60 | $41.00 | $4.27 – $4.27 | 1 |
| Ghs semen analysis fert CPT 89320 | $112.20 | $187.00 | $12.31 – $12.31 | 1 |
| Ghs semen analysis, post-vas CPT 89300 | $58.80 | $98.00 | $9.84 – $9.84 | 1 |
| Ghs sensitivity (per antimicro) CPT 87184 | $63.60 | $106.00 | $7.48 – $7.48 | 1 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $309.00 | $515.00 | $305.50 – $382.44 | 2 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $399.00 | $665.00 | $323.05 – $382.44 | 2 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $372.00 | $620.00 | $305.50 – $382.44 | 2 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $550.80 | $918.00 | $323.05 – $382.44 | 2 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $270.00 | $450.00 | $190.20 – $266.28 | 2 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $268.80 | $448.00 | $190.20 – $266.28 | 2 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $322.20 | $537.00 | $190.20 – $266.28 | 2 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $431.40 | $719.00 | $190.20 – $266.28 | 2 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $313.20 | $522.00 | $190.20 – $266.28 | 2 |
| Ghs sleep study unattended CPT 95800 | $799.20 | $1,332.00 | $149.77 – $209.67 | 2 |
| Ghs somatosensory testing lower extremit CPT 95926 | $346.80 | $578.00 | $298.08 – $375.70 | 2 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $676.80 | $1,128.00 | $507.90 – $711.06 | 2 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $154.80 | $258.00 | $60.57 – $60.57 | 1 |
| Ghs sphenopalatine ganglion block CPT 64505 | $442.80 | $738.00 | $282.56 – $395.59 | 2 |
| Ghs spont nystagmus CPT 92541 | $129.00 | $215.00 | $123.39 – $139.75 | 2 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $164.40 | $274.00 | $128.79 – $128.79 | 1 |
| Ghs st - eval for alt comm CPT 92567 | $119.40 | $199.00 | $37.57 – $52.60 | 2 |
| Ghs strapping shoulder - 29240 CPT 29240 | $129.00 | $215.00 | $123.39 – $139.75 | 2 |
| Ghs st - re-eval for alt comm CPT 92597 | $125.40 | $209.00 | $93.37 – $93.37 | 1 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $37.80 | $63.00 | $40.95 – $44.17 | 2 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $315.60 | $526.00 | $201.68 – $282.35 | 2 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $495.60 | $826.00 | $264.55 – $585.94 | 2 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $300.00 | $500.00 | $277.55 – $382.44 | 2 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $998.40 | $1,664.00 | $1,081.60 – $1,417.91 | 2 |
| Ghs trypsin (fecal) CPT 84488 | $97.20 | $162.00 | $7.30 – $7.30 | 1 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $562.80 | $938.00 | $229.62 – $321.47 | 2 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $453.00 | $755.00 | $229.62 – $321.47 | 2 |
| Ghs urine, hydroxproline total CPT 83505 | $201.60 | $336.00 | $24.30 – $24.30 | 1 |
| Ghs urine, porphyrins quant CPT 84120 | $152.40 | $254.00 | $14.71 – $14.71 | 1 |
| Ghs vaginal delivery only CPT 59409 | $2,042.40 | $3,404.00 | $2,212.60 – $3,043.51 | 2 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $1,416.00 | $2,360.00 | $507.90 – $711.06 | 2 |
| Ghs windowing of cast CPT 29730 | $125.40 | $209.00 | $135.85 – $151.04 | 2 |
| Giardia ag if CPT 87269 | not published | not published | $13.61 – $13.61 | 1 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $14.72 – $14.72 | 1 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $231.38 – $323.93 | 2 |
| Gi inhouse confirmation CPT 87045 | $78.00 | $130.00 | $9.44 – $9.44 | 1 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $3,104.33 – $4,346.06 | 2 |
| Gi protein loss CPT 78282 | not published | not published | $384.64 – $538.50 | 2 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,281.60 | $2,136.00 | not published | 0 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $872.71 – $1,221.79 | 2 |
| Gi trc img intral esophagus CPT 91111 | $72.60 | $121.00 | $897.45 – $1,256.43 | 2 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $897.45 – $1,256.43 | 2 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $101.12 | 1 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $61.52 | 1 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $35.00 | 1 |
| Glassia injection HCPCS J0257 | $40.24 | $67.06 | $5.71 – $7.99 | 2 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $23.44 – $32.82 | 2 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $37.57 – $52.60 | 2 |
| Glaucoma surgery CPT 66150 | not published | not published | $3,850.76 – $5,391.07 | 2 |
| Glaucoma surgery CPT 66155 | not published | not published | $3,850.76 – $5,391.07 | 2 |
| Glaucoma surgery CPT 66160 | not published | not published | $2,183.16 – $3,056.42 | 2 |
| Glaucoma surgery CPT 66170 | not published | not published | $2,183.16 – $3,056.42 | 2 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $509.77 | $849.62 | $195.79 – $274.11 | 2 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $144.88 – $202.83 | 2 |
| Glucagon plasma - sendout CPT 82943 | $217.20 | $362.00 | $14.29 – $14.29 | 1 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $46.07 | 1 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $50.50 | 1 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.77 – $17.77 | 1 |
| Glucose 1 hr post dose CPT 82950 | $35.40 | $59.00 | $4.75 – $4.75 | 1 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $6.05 | 1 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $25.80 | $43.00 | $3.28 – $3.28 | 1 |
| Glucose blood quantitative CPT 82947 | $76.20 | $127.00 | $3.93 – $3.93 | 1 |
| Glucose body fluid CPT 82945 | $46.80 | $78.00 | $3.93 – $3.93 | 1 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $171.00 | $285.00 | not published | 0 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $67.20 | $112.00 | $12.87 – $12.87 | 1 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $64.20 | $107.00 | $3.92 – $3.92 | 1 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.43 – $0.60 | 2 |
| Gold sodium thiomaleate inj HCPCS J1600 | $62.81 | $104.68 | not published | 0 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $914.85 | $1,524.75 | $11.03 – $15.44 | 2 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $101.40 | $169.00 | $18.58 – $18.58 | 1 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $148.41 | 1 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $102.60 | $171.00 | $18.52 – $18.52 | 1 |
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.