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 |
|---|---|---|---|---|
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $495.00 | $495.00 | $0.86 – $495.00 | 106 |
| Sp bone algrft morsel add-on CPT 20930 | $72,037.86 | not published | $9.09 – $52,678.33 | 82 |
| Special physics consult CPT 77370 | $601.25 | $925.00 | $126.87 – $925.00 | 109 |
| Special radiation dosimetry CPT 77331 | $149.00 | $149.00 | $7.44 – $260.94 | 780 |
| Special radiation treatment CPT 77470 | $1,905.15 | $2,931.00 | $67.73 – $2,931.00 | 780 |
| Specific gravity body fluid CPT 84315 | $44.85 | $69.00 | $3.18 – $69.00 | 43 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $668.00 | $668.00 | $87.64 – $440.25 | 780 |
| Speech Therapy Session (one-on-one) CPT 92507 | $1,068.00 | $356.00 | $17.15 – $356.00 | 780 |
| Spinal bone allograftstructural 20931 CPT 20931 | $72,410.88 | $364.00 | $9.09 – $52,678.33 | 769 |
| Spinal bone autograftlocal 20936 CPT 20936 | $72,824.34 | not published | $9.09 – $34,040.37 | 82 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,329.25 | $2,045.00 | $411.05 – $2,045.00 | 108 |
| Spine X-ray (single view, one level) CPT 72020 | $301.60 | $464.00 | $82.14 – $464.00 | 109 |
| Splint arm vnyl coated padded lft med HCPCS Q4051 | $16.25 | $25.00 | $5.03 – $25.00 | 28 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $43.09 | $66.30 | $4.77 – $29.20 | 36 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $50.38 | $77.51 | $6.45 – $39.50 | 36 |
| Splint finger 4 prong foam sm HCPCS A4570 | $0.55 | $0.85 | $0.13 – $0.67 | 28 |
| Splint finger fold over sm HCPCS L3924 | $0.44 | $0.67 | $0.13 – $0.67 | 28 |
| Splint finger frog med HCPCS L3927 | $0.54 | $0.83 | $0.06 – $0.39 | 36 |
| Splint fing stax assort 1-7in HCPCS Q4049 | $1.04 | $1.60 | $0.32 – $1.60 | 28 |
| Splint func pos polyflex ii med HCPCS L3999 | $33.60 | $51.70 | $8.44 – $51.70 | 36 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $101.18 | $155.66 | $7.89 – $48.35 | 36 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $35,119.33 | not published | $0.96 – $6,879.83 | 82 |
| Split blood or products CPT 86985 | $125.45 | $193.00 | $38.79 – $330.76 | 109 |
| Sputum specimen collection CPT 89220 | $104.00 | $160.00 | $32.16 – $330.76 | 106 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $40,862.00 | $40,862.00 | $1,992.51 – $9,913.00 | 106 |
| Srs linear based CPT 77372 | $22,795.50 | $35,070.00 | $3,517.00 – $35,070.00 | 109 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $289.25 | $445.00 | $88.93 – $445.00 | 43 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $1,265.00 | $553.00 | $69.81 – $481.00 | 779 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $60,817.04 | $2,316.00 | $9.09 – $1,857.63 | 767 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $32,403.15 | $49,851.00 | $0.01 – $11.31 | 28 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $6,063.30 | $9,328.16 | $5.98 – $29.75 | 28 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $18,714.49 | $28,791.53 | $0.47 – $2.32 | 28 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $4,918.86 | $7,567.48 | $169.44 – $843.00 | 28 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $60,817.04 | $84,634.00 | $4.71 – $56,423.00 | 779 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $34,986.24 | $1,360.00 | $9.09 – $785.59 | 767 |
| Stent placemt retro carotid CPT 37217 | $5,623.15 | $8,651.00 | $1,159.17 – $5,767.00 | 27 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $2,235.00 | $2,235.00 | $232.55 – $1,820.36 | 767 |
| Stereoscopic x-ray guidance HCPCS G6002 | $236.00 | $236.00 | $13.76 – $51.69 | 767 |
| Stereotactic bx aspir/exc burr intracranial les 61750 CPT 61750 | $4,252.00 | $4,252.00 | $441.76 – $3,149.00 | 768 |
| Stereotactic radiation trmt CPT 77432 | $1,370.00 | $1,370.00 | $270.51 – $1,211.76 | 768 |
| Sternal debridement CPT 21627 | $2,155.00 | $2,155.00 | $177.11 – $1,862.50 | 768 |
| St evaluate speech sound production CPT 92522 | $289.25 | $445.00 | $86.24 – $445.00 | 43 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $340.60 | $524.00 | $84.86 – $504.00 | 43 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $1,459.25 | $2,245.00 | $377.34 – $2,245.00 | 109 |
| Strap chin dlx f/cpap HCPCS A7036 | $34.90 | $53.70 | $10.79 – $53.70 | 28 |
| Strap montgmry ns 8 hl sht 7.25 x 11.25in HCPCS A4461 | $0.25 | $0.39 | $0.08 – $0.39 | 28 |
| Streptomycin injection HCPCS J3000 | $344.95 | $344.95 | $31.35 – $344.95 | 94 |
| Stress test pulmonary CPT 94618 | $443.95 | $683.00 | $14.48 – $683.00 | 781 |
| Stress tte complete CPT 93351 | $2,634.45 | $4,053.00 | $515.76 – $4,053.00 | 109 |
| Str markers specimen anal CPT 81265 | $1,240.85 | $1,909.00 | $228.41 – $1,909.00 | 40 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $77.20 | $77.20 | $0.60 – $3.00 | 28 |
| Suction lipectomy lwr extrem CPT 15879 | $10,160.00 | not published | $3,354.35 – $6,879.83 | 78 |
| Suction lipectomy trunk CPT 15877 | $4,953.00 | not published | $3,354.35 – $6,879.83 | 78 |
| Suction lipectomy upr extrem CPT 15878 | $49,671.22 | not published | $371.96 – $7,601.47 | 82 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $23.00 | $23.00 | $4.62 – $23.00 | 28 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $41.40 | $41.40 | $8.28 – $234.80 | 102 |
| Support clav 29.6-40.5in med HCPCS L3650 | $94.19 | $144.91 | $0.53 – $3.26 | 36 |
| Surg dx exam anorectal CPT 45990 | $6,001.40 | $381.00 | $31.74 – $5,388.70 | 769 |
| Surgical pathology level 1 gross examination only CPT 88300 | $96.85 | $149.00 | $24.96 – $137.00 | 109 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $176.15 | $271.00 | $24.96 – $271.00 | 109 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $275.60 | $424.00 | $49.19 – $424.00 | 109 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $13,696.00 | $562.00 | $31.45 – $374.00 | 109 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $465.40 | $716.00 | $143.92 – $716.00 | 109 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $613.60 | $944.00 | $189.74 – $1,564.16 | 109 |
| Susceptibility agar dilution per agent CPT 87181 | $52.00 | $80.00 | $4.60 – $80.00 | 43 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $28.60 | $44.00 | $4.60 – $44.00 | 43 |
| Susceptibility mic per plate CPT 87186 | $203.45 | $313.00 | $8.38 – $108.00 | 43 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | $3,770.00 | $3,770.00 | $37.48 – $364.32 | 768 |
| Suture bile duct injury 47900 CPT 47900 | $7,381.00 | $7,381.00 | $413.86 – $4,921.00 | 768 |
| Svc venogram s&i CPT 75827 | $40,241.17 | $5,238.00 | $0.96 – $5,238.00 | 109 |
| Swallowing Evaluation (Bedside) CPT 92610 | $524.00 | $524.00 | $55.26 – $524.00 | 43 |
| Swallowing Therapy Session CPT 92526 | $141.05 | $217.00 | $43.62 – $217.00 | 43 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $44.85 | $69.00 | $4.26 – $69.00 | 43 |
| System cardiomems hosp electronics HCPCS C2624 | $24,023.02 | $36,958.50 | $3,179.13 – $15,816.55 | 28 |
| System pacing micra av HCPCS C1786 | $16,760.25 | $25,785.00 | $15.58 – $77.51 | 28 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $27,099.09 | $41,690.91 | $22.10 – $109.96 | 28 |
| System recell skin grafting/harvesting HCPCS C1832 | $8,955.20 | $13,777.23 | $2,769.22 – $13,777.23 | 28 |
| System sealant biosentry tract HCPCS C2613 | $652.35 | $1,003.62 | $201.73 – $1,003.62 | 28 |
| T3 (triiodothyronine) free CPT 84481 | $156.00 | $240.00 | $16.41 – $240.00 | 43 |
| T3 (triiodothyronine) total CPT 84480 | $173.55 | $267.00 | $13.74 – $267.00 | 43 |
| T4 (thyroxine) free CPT 84439 | $38,275.10 | $379.00 | $8.74 – $12,818.00 | 109 |
| T4 (thyroxine) total CPT 84436 | $196.95 | $303.00 | $6.66 – $303.00 | 43 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $170.70 | $170.70 | $0.15 – $1.00 | 94 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $1,208.10 | $1,208.10 | $242.83 – $1,208.10 | 94 |
| Tacrolimus therapeutic drug level CPT 80197 | $224.25 | $345.00 | $13.30 – $345.00 | 43 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | $4,272.00 | $4,272.00 | $13.52 – $4,272.00 | 109 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $406.25 | $625.00 | $5.33 – $625.00 | 780 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | $88,021.00 | $88,021.00 | $65.46 – $880.35 | 109 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | $35,941.50 | $35,941.50 | $73.42 – $4,492.75 | 106 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | $3.04 | $4.67 | $0.94 – $4.67 | 28 |
| Target gsa panel hmtlmph neop CPT 81450 | $989.95 | $1,523.00 | $306.12 – $1,526.66 | 43 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $46,350.00 | $46,350.00 | $931.64 – $4,635.00 | 106 |
| Tavr perq femoral CPT 33361 | $7,454.20 | $11,468.00 | $344.10 – $10,023.00 | 779 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $463.10 | $463.10 | $0.24 – $289.40 | 109 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $162.50 | $250.00 | $40.20 – $201.00 | 43 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $385.45 | $593.00 | $60.06 – $593.00 | 43 |
| Tc-99m apcitide diag HCPCS A9504 | $1,765.30 | $1,765.30 | $354.83 – $1,765.30 | 28 |
| Tc-99m arcitumomab HCPCS A9568 | $4,224.15 | $4,224.15 | $689.38 – $4,224.15 | 36 |
| Tc-99m bicisate HCPCS A9557 | $7,128.20 | $7,128.20 | $760.01 – $7,128.20 | 106 |
| Tc-99m depreotide HCPCS A9536 | $1,937.35 | $1,937.35 | $389.41 – $1,937.35 | 28 |
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.