MercyOne Genesis DeWitt Medical Center
1118 11th Street, DeWitt, IA · MercyOne · · NPI 1407938269
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 |
|---|---|---|---|---|
| Destruction 2-14 lesions 17003 CPT 17003 | $21.00 | $35.00 | $25.55 – $2,679.00 | 3 |
| Destruction anal lesion(s) CPT 46910 | $475.20 | $792.00 | $578.16 – $2,679.00 | 3 |
| Destruction anal lesion(s) CPT 46924 | $1,010.40 | $1,684.00 | $928.00 – $2,679.00 | 3 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | $450.60 | $751.00 | $548.23 – $2,679.00 | 3 |
| Destruction benign lesions < 14 lesions CPT 17110 | $210.60 | $351.00 | $256.23 – $2,679.00 | 3 |
| Destruction by injection tx of nerve 64630 CPT 64630 | $444.60 | $741.00 | $540.93 – $2,679.00 | 3 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $1,363.80 | $2,273.00 | $394.20 – $515.10 | 3 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $3,442.80 | $5,738.00 | $928.00 – $1,300.50 | 3 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $442.20 | $737.00 | $538.01 – $2,679.00 | 3 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | $872.40 | $1,454.00 | $928.00 – $2,679.00 | 3 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $411.00 | $685.00 | $500.05 – $2,679.00 | 3 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $376.20 | $627.00 | $457.71 – $2,679.00 | 3 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $395.40 | $659.00 | $481.07 – $2,679.00 | 3 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $475.20 | $792.00 | $578.16 – $2,679.00 | 3 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $251.40 | $419.00 | $305.87 – $2,679.00 | 3 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $424.20 | $707.00 | $516.11 – $2,679.00 | 3 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $327.60 | $546.00 | $398.58 – $2,679.00 | 3 |
| Destruction rectal tumor 45190 CPT 45190 | $1,093.80 | $1,823.00 | $928.00 – $2,679.00 | 3 |
| Destruction vag lesions complex 57065 CPT 57065 | $456.00 | $760.00 | $554.80 – $2,679.00 | 3 |
| Destruction vag lesions simple 57061 CPT 57061 | $220.80 | $368.00 | $268.64 – $2,679.00 | 3 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $397.80 | $663.00 | $483.99 – $2,679.00 | 3 |
| Developmental screen/score/document 96110 CPT 96110 | $25.20 | $42.00 | $30.66 – $2,679.00 | 3 |
| Devel tst phys/qhp 1st hr CPT 96112 | $18.60 | $31.00 | $10.54 – $22.63 | 3 |
| Device ablt adv novasure HCPCS C1886 | $2,287.80 | $3,813.00 | $1,296.42 – $2,783.49 | 3 |
| Device intraute mirena HCPCS J7298 | $2,161.20 | $3,602.00 | $1,224.68 – $2,629.46 | 3 |
| Device tiss remov myosure reach HCPCS C1782 | $2,122.80 | $3,538.00 | $637.50 – $1,368.75 | 3 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $229.20 | $382.00 | $129.88 – $278.86 | 3 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $2.23 | $3.71 | $1.13 – $2.42 | 3 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $47.02 | $78.37 | $7.87 – $16.89 | 3 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $853.51 | $1,422.52 | $204.44 – $438.94 | 3 |
| Dextran 40 infusion HCPCS J7100 | $28.53 | $47.55 | $15.77 – $33.86 | 3 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $34.90 | $58.16 | $19.77 – $42.46 | 3 |
| Dextrose 5 % IV bolus HCPCS J7070 | $37.55 | $62.58 | $21.28 – $45.68 | 3 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $133.20 | $222.00 | $42.16 – $90.52 | 3 |
| Diabetes (HbA1c) Test CPT 83036 | $50.40 | $84.00 | $18.70 – $27.74 | 3 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $16.80 | $28.00 | $20.44 – $2,679.00 | 3 |
| Diab manage trn ind/group HCPCS G0109 | $37.80 | $63.00 | $45.99 – $2,679.00 | 3 |
| Diag laparo separate proc 49320 CPT 49320 | $619.80 | $1,033.00 | $754.09 – $2,679.00 | 3 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $165.00 | $275.00 | $200.75 – $2,679.00 | 3 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $31.20 | $52.00 | $17.68 – $37.96 | 3 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $31.20 | $52.00 | $17.68 – $37.96 | 3 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $162.60 | $271.00 | $79.56 – $170.82 | 3 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $301.20 | $502.00 | $135.66 – $291.27 | 3 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $295.80 | $493.00 | $48.28 – $103.66 | 3 |
| Diagnostic Mammogram (one breast) CPT 77065 | $231.60 | $386.00 | $33.66 – $72.27 | 3 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $347.40 | $579.00 | $422.67 – $2,679.00 | 3 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $86.95 | $144.91 | $18.09 – $38.85 | 3 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $939.09 | $1,565.15 | $9.17 – $19.70 | 3 |
| Dicyclomine injection HCPCS J0500 | $161.30 | $268.84 | $21.39 – $45.92 | 3 |
| Diffusing capacity CPT 94729 | $154.80 | $258.00 | $32.12 – $87.72 | 3 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $23.45 | $39.09 | $8.84 – $18.99 | 3 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $8,839.56 | $14,732.60 | $5,009.08 – $10,754.80 | 3 |
| Digoxin total therapeutic drug level CPT 80162 | $81.60 | $136.00 | $40.12 – $86.14 | 3 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $245.07 | $408.45 | $43.97 – $94.41 | 3 |
| Dilate esophagus 1/mult pass CPT 43450 | $303.60 | $506.00 | $369.38 – $2,679.00 | 3 |
| Dilation/female urethra/initial 53660 CPT 53660 | $138.60 | $231.00 | $168.63 – $2,679.00 | 3 |
| Dilation of anal sphincter CPT 45905 | $352.80 | $588.00 | $429.24 – $2,679.00 | 3 |
| Dilation of cervical canal 57800 CPT 57800 | $115.80 | $193.00 | $140.89 – $2,679.00 | 3 |
| Dilation of rectal stricture 45910 CPT 45910 | $1,032.00 | $1,720.00 | $928.00 – $2,679.00 | 3 |
| Dilation salivary duct 42650 CPT 42650 | $164.40 | $274.00 | $200.02 – $2,679.00 | 3 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $231.00 | $385.00 | $281.05 – $2,679.00 | 3 |
| Dilator fascial 10fx20cm HCPCS C2627 | $160.20 | $267.00 | $24.14 – $51.83 | 3 |
| Dimecaprol injection HCPCS J0470 | $158.35 | $263.92 | $89.73 – $192.66 | 3 |
| Dimenhydrinate injection HCPCS J1240 | $22.36 | $37.26 | $12.67 – $27.20 | 3 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $98.40 | $164.00 | $55.76 – $119.72 | 3 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $0.35 | $0.58 | $0.20 – $0.42 | 3 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $17.75 | $29.59 | $8.21 – $17.64 | 3 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | $20.32 | $33.86 | $11.51 – $24.72 | 3 |
| Direct advanced life support CPT 99288 | $241.20 | $402.00 | $293.46 – $2,679.00 | 3 |
| Disability dlco CPT 94727 | $191.40 | $319.00 | $97.09 – $108.46 | 3 |
| Disaccharidases CPT 82657 | $174.00 | $290.00 | $35.36 – $75.92 | 3 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | $2,813.40 | $4,689.00 | $928.00 – $3,422.97 | 3 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | $370.20 | $617.00 | $450.41 – $2,679.00 | 3 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | $94.80 | $158.00 | $115.34 – $2,679.00 | 3 |
| Dist revas ligation hemo CPT 36838 | $2,282.40 | $3,804.00 | $928.00 – $2,776.92 | 3 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | $1,542.60 | $2,571.00 | $928.00 – $2,679.00 | 3 |
| Division of fallopian tube 58605 CPT 58605 | $641.40 | $1,069.00 | $780.37 – $2,679.00 | 3 |
| #d/lmeth-l-methamphetamine CPT 80374 | $213.60 | $356.00 | $121.04 – $259.88 | 3 |
| Dna antibody native/double stranded CPT 86225 | $102.60 | $171.00 | $19.72 – $42.34 | 3 |
| Dna gardnerella CPT 87510 | $74.40 | $124.00 | $29.58 – $63.51 | 3 |
| Dna probe chlamydia CPT 87490 | $57.00 | $95.00 | $32.30 – $69.35 | 3 |
| Dna probe gc CPT 87590 | $56.40 | $94.00 | $31.96 – $68.62 | 3 |
| Dna trichomonas CPT 87660 | $74.40 | $124.00 | $31.28 – $67.16 | 3 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $50.08 | $83.47 | $10.90 – $23.41 | 3 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $528.48 | $880.80 | $276.45 – $593.55 | 3 |
| Dolasetron mesylate HCPCS J1260 | $116.27 | $193.78 | $65.89 – $141.46 | 3 |
| Dolasetron mesylate oral HCPCS Q0180 | $114.21 | $190.35 | $49.07 – $105.35 | 3 |
| Domicil/r-home visit est pat CPT 99334 | $117.00 | $195.00 | $142.35 – $2,679.00 | 3 |
| Domicil/r-home visit est pat CPT 99335 | $183.60 | $306.00 | $223.38 – $2,679.00 | 3 |
| Domicil/r-home visit est pat CPT 99336 | $259.80 | $433.00 | $316.09 – $2,679.00 | 3 |
| Domicil/r-home visit est pat CPT 99337 | $372.60 | $621.00 | $453.33 – $2,679.00 | 3 |
| Domicil/r-home visit new pat CPT 99324 | $110.40 | $184.00 | $134.32 – $2,679.00 | 3 |
| Domicil/r-home visit new pat CPT 99325 | $159.00 | $265.00 | $193.45 – $2,679.00 | 3 |
| Domicil/r-home visit new pat CPT 99326 | $271.80 | $453.00 | $330.69 – $2,679.00 | 3 |
| Domicil/r-home visit new pat CPT 99327 | $360.60 | $601.00 | $438.73 – $2,679.00 | 3 |
| Domicil/r-home visit new pat CPT 99328 | $418.80 | $698.00 | $509.54 – $2,679.00 | 3 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $19.51 | $32.52 | $9.60 – $20.61 | 3 |
| Doppler echo complete CPT 93320 | $938.40 | $1,564.00 | $174.42 – $192.72 | 3 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $414.60 | $691.00 | $24.82 – $234.94 | 3 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $198.60 | $331.00 | $13.87 – $81.94 | 3 |
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.