MercyOne Des Moines Medical Center
1111 6th Ave, Des Moines, IA · MercyOne · Nonprofit · NPI 1234567893
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 |
|---|---|---|---|---|
| Rtm 1st set-up&pt educaj eqp CPT 98975 | $117.00 | $180.00 | $36.18 – $190.00 | 28 |
| Rubella antibody igg CPT 86762 | $152.75 | $235.00 | $13.94 – $156.00 | 43 |
| Rubeola antibody igg CPT 86765 | $92.30 | $142.00 | $12.48 – $142.00 | 43 |
| Russell viper venom diluted CPT 85613 | $203.45 | $313.00 | $9.28 – $313.00 | 43 |
| Sacituzumab govitecan-hziy 180 mg intravenous solution HCPCS J9317 | $7,844.35 | $7,844.35 | $33.65 – $7,844.35 | 109 |
| Sacroiliac Joint X-ray (3 or more views) CPT 72202 | $390.00 | $600.00 | $6.60 – $600.00 | 780 |
| Same day nb discharge 99463 CPT 99463 | $265.00 | $265.00 | $60.49 – $229.00 | 768 |
| Sbrt management CPT 77435 | $2,068.00 | $2,068.00 | $408.96 – $1,859.87 | 768 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $532.00 | $732.00 | $23.86 – $732.00 | 780 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $345.00 | $348.00 | $14.70 – $348.00 | 780 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $756.60 | $1,164.00 | $14.91 – $1,164.00 | 780 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $1,021.15 | $1,571.00 | $12.99 – $1,571.00 | 780 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $3,874.00 | $1,412.00 | $14.27 – $1,412.00 | 780 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $759.85 | $1,169.00 | $14.48 – $1,169.00 | 780 |
| Scan proc cranial extra CPT 61782 | $34,393.75 | $538.00 | $0.96 – $13,701.44 | 769 |
| Scan proc cranial intra 61781 CPT 61781 | $706.00 | $706.00 | $21.34 – $82.08 | 768 |
| Scan proc spinal CPT 61783 | $80,407.77 | not published | $9.09 – $52,678.33 | 82 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $1,829.10 | $2,814.00 | $565.61 – $3,206.43 | 108 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $2,514.76 | $3,868.86 | $364.60 – $1,813.91 | 28 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $25,763.87 | $870.00 | $1.92 – $1,805.43 | 769 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $10,212.65 | $869.00 | $0.96 – $1,805.43 | 769 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $48.75 | $75.00 | $15.08 – $75.00 | 40 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | $89.70 | $138.00 | $27.70 – $138.00 | 40 |
| Screening hepatitis c antibody high risk HCPCS G0472 | $45.50 | $70.00 | $14.07 – $93.16 | 43 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | $58.50 | $90.00 | $18.09 – $90.00 | 40 |
| Screening Mammogram CPT 77067 | $884.00 | $831.00 | $81.59 – $553.00 | 109 |
| Screening prostate cancer PSA HCPCS G0103 | $137.15 | $211.00 | $18.92 – $211.00 | 40 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $776,558.25 | $1,194,705.00 | $0.01 – $24,925.18 | 109 |
| Scrotal (Testicle) Ultrasound CPT 76870 | $856.70 | $1,318.00 | $98.68 – $1,318.00 | 109 |
| Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time HCPCS G0500 | $13,025.10 | $268.00 | $3.41 – $2,323.17 | 780 |
| Sedimentation rate erythrocyte automated CPT 85652 | $70.85 | $109.00 | $2.62 – $109.00 | 43 |
| Segmentectomy 32484 CPT 32484 | $4,396.00 | $4,396.00 | $37.48 – $570.40 | 768 |
| Self-Care and Home Skills Training (each 15 minutes) CPT 97535 | $104.00 | $160.00 | $20.66 – $160.00 | 780 |
| Semen analysis presence/motility CPT 89321 | $89.70 | $138.00 | $11.68 – $138.00 | 43 |
| Semen analysis w/count CPT 89310 | $68.90 | $106.00 | $8.34 – $106.00 | 43 |
| Set radiation therapy field CPT 77280 | $848.00 | $848.00 | $23.64 – $585.00 | 780 |
| Set radiation therapy field CPT 77290 | $2,036.45 | $3,133.00 | $52.19 – $3,133.00 | 780 |
| Sevelamer carbonate 800 mg tablet HCPCS J0601 | $1.00 | $1.00 | $0.20 – $6.38 | 99 |
| Sevelamer carbonate pdr 20mg HCPCS J0602 | $1.05 | $1.05 | $0.21 – $17.40 | 99 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $4,730.47 | $7,277.64 | $146.85 – $730.60 | 28 |
| Sheath laser cavaclear 14f HCPCS C1603 | $5,815.06 | $8,946.25 | $1,336.30 – $6,648.28 | 28 |
| Shoe post-op mens m HCPCS L3260 | $42.87 | $65.95 | $0.47 – $2.90 | 36 |
| Shot (Injection into Muscle or Under the Skin) CPT 96372 | $4,125.00 | $202.00 | $3.77 – $202.00 | 780 |
| Shoulder AC Joint X-ray (both sides) CPT 73050 | $352.30 | $542.00 | $5.96 – $542.00 | 780 |
| Shoulder Blade (Scapula) X-ray (both sides) CPT 73010 | $585.65 | $901.00 | $5.75 – $601.00 | 780 |
| Shoulder MRI (with and without contrast) CPT 73223 | $6,756.75 | $10,395.00 | $329.29 – $6,930.00 | 109 |
| Shoulder MRI (with contrast) CPT 73222 | $6,268.60 | $9,644.00 | $739.93 – $6,429.00 | 109 |
| Shoulder MRI (without contrast) CPT 73221 | $3,722.55 | $5,727.00 | $126.95 – $3,818.00 | 109 |
| Shoulder X-ray CPT 73030 | $40,792.26 | $998.00 | $5.75 – $665.00 | 780 |
| Shoulder X-ray (single view, both shoulders) CPT 73020 | $443.95 | $683.00 | $82.14 – $455.00 | 109 |
| Shrinker prosth above knee HCPCS L8460 | $230.16 | $354.09 | $71.17 – $354.09 | 28 |
| Shrinker prosth below knee HCPCS L8440 | $178.63 | $274.82 | $55.24 – $274.82 | 28 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $3,209.23 | $4,937.28 | $35.90 – $178.61 | 28 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $492.70 | $758.00 | $98.68 – $758.00 | 109 |
| Sickling rbc CPT 85660 | $92.95 | $143.00 | $5.33 – $143.00 | 43 |
| Sigmoidoscopy and biopsy CPT 45331 | $7,948.10 | $263.00 | $2.15 – $1,805.43 | 769 |
| Sigmoidoscopy flex decompression 45337 CPT 45337 | $416.00 | $416.00 | $31.85 – $392.40 | 768 |
| Sigmoidoscopy for bleeding CPT 45334 | $428.00 | $428.00 | $16.30 – $428.00 | 768 |
| Sigmoidoscopy/submucosal injection 45335 CPT 45335 | $7,008.70 | $243.00 | $9.09 – $1,805.43 | 769 |
| Sigmoidoscopy w/ablation CPT 45346 | $7,364.45 | $585.00 | $1.44 – $2,323.17 | 769 |
| Sigmoidoscopy w/tumr remove CPT 45338 | $11,000.60 | $437.00 | $34.72 – $2,323.17 | 769 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $628.40 | $628.40 | $126.31 – $628.40 | 94 |
| Sinus CT scan (with and without contrast) CPT 70488 | $1,218.10 | $1,874.00 | $165.56 – $1,874.00 | 109 |
| Sinus CT scan (with contrast) CPT 70487 | $2,146.95 | $3,303.00 | $165.56 – $3,303.00 | 109 |
| Sinus CT scan (without contrast) CPT 70486 | $1,165.45 | $1,793.00 | $25.35 – $1,793.00 | 780 |
| Sinus/juglr venogram s&i CPT 75860 | $3,728.40 | $5,736.00 | $1,152.94 – $6,702.68 | 109 |
| Sinus X-ray (complete) CPT 70220 | $419.25 | $645.00 | $82.14 – $645.00 | 109 |
| Sirolimus, oral HCPCS J7520 | $6.20 | $6.20 | $0.66 – $3.30 | 94 |
| Sirolimus-protein bound 100 mg intravenous suspension HCPCS J9331 | $42,938.50 | $42,938.50 | $8,630.64 – $42,938.50 | 94 |
| Skin Biopsy CPT 11102 | $261.30 | $402.00 | $9.59 – $789.21 | 780 |
| Skin full graft 20sq cm less 15200 CPT 15200 | $59,728.88 | $2,196.00 | $139.10 – $12,891.30 | 769 |
| Skin pedicle flap arms/legs CPT 15572 | $49,715.25 | not published | $62.90 – $15,867.92 | 82 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | $35,119.33 | $358.00 | $0.96 – $6,879.83 | 769 |
| Skull X-ray (1 to 3 views) CPT 70250 | $371.15 | $571.00 | $5.54 – $571.00 | 780 |
| Skull X-ray (complete) CPT 70260 | $534.95 | $823.00 | $98.68 – $823.00 | 109 |
| Sleep Study (Polysomnography) CPT 95810 | $6,003.40 | $9,236.00 | $76.25 – $9,236.00 | 780 |
| Sleep study unattended CPT 95806 | $1,229.00 | $1,229.00 | $28.54 – $141.67 | 768 |
| Sleeve fing rolyan med HCPCS L3933 | $37.65 | $57.93 | $11.64 – $57.93 | 28 |
| Sleeve irr assura 1pc disp HCPCS A4397 | $0.65 | $1.00 | $0.20 – $1.00 | 28 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $529.06 | $813.94 | $0.42 – $460.33 | 36 |
| Sling pelv split sam med HCPCS L0621 | $165.55 | $254.70 | $41.57 – $254.70 | 36 |
| Sling suprapubic suburetheral HCPCS C1771 | $9,202.85 | $14,158.23 | $410.39 – $2,041.75 | 28 |
| Slp stdy unatnd w/anal CPT 95801 | $367.00 | $367.00 | $23.43 – $104.00 | 768 |
| Sm-153 lexidron ther HCPCS A9604 | $57,456.00 | $57,456.00 | $4,314.91 – $57,456.00 | 94 |
| Small Bowel Barium X-ray (Follow-Through) CPT 74250 | $657.15 | $1,011.00 | $165.56 – $1,011.00 | 109 |
| Small bowel endoscopy CPT 44366 | $874.00 | $874.00 | $67.10 – $679.31 | 768 |
| Small bowel endoscopy CPT 44369 | $8,526.88 | not published | $1.76 – $3,725.39 | 82 |
| Small bowel endoscopy/biopsy CPT 44361 | $577.00 | $577.00 | $44.84 – $434.46 | 768 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $19,115.87 | $145.00 | $5.22 – $1,585.19 | 109 |
| Smear gram stain CPT 87205 | $11,327.62 | $149.00 | $4.14 – $1,687.37 | 109 |
| Smear nasal eosinophil CPT 89190 | $18.20 | $28.00 | $5.61 – $28.00 | 43 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $157.95 | $243.00 | $5.80 – $68.00 | 43 |
| Sock wool above knee HCPCS L8430 | $158.68 | $244.12 | $49.07 – $244.12 | 28 |
| Sodium 24 hour urine CPT 84300 | $73.45 | $113.00 | $4.91 – $113.00 | 43 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $25.00 | $25.00 | $4.02 – $20.00 | 28 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $20.00 | $20.00 | $2.01 – $10.00 | 28 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $33.00 | $33.00 | $3.27 – $16.25 | 28 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $30.00 | $30.00 | $2.51 – $75.00 | 94 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $292.60 | $292.60 | $8.21 – $40.85 | 94 |
| Sodium serum/plasma/whole blood CPT 84295 | $43,411.17 | $118.00 | $4.66 – $13,116.76 | 109 |
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.