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 |
|---|---|---|---|---|
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $6,142.80 | $10,238.00 | $1,179.80 – $2,533.10 | 3 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $53,325.60 | $88,876.00 | $46.24 – $99.28 | 3 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $5,876.40 | $9,794.00 | $66.30 – $142.35 | 3 |
| Granisetron 1 mg tab HCPCS Q0166 | $94.60 | $157.66 | $40.30 – $86.52 | 3 |
| Granisetron hcl injection HCPCS J1626 | $300.53 | $500.89 | $16.07 – $34.51 | 3 |
| Great toe with reduction 28495 CPT 28495 | $338.40 | $564.00 | $411.72 – $2,679.00 | 3 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | $930.00 | $1,550.00 | $928.00 – $2,679.00 | 3 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | $907.20 | $1,512.00 | $928.00 – $2,679.00 | 3 |
| Grfg autol fat lipo ea addl CPT 15772 | $291.00 | $485.00 | $354.05 – $2,679.00 | 3 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $39.60 | $66.00 | $48.18 – $2,679.00 | 3 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | $3,604.20 | $6,007.00 | $928.00 – $4,385.11 | 3 |
| Gstrst open wo constj tube CPT 43830 | $1,315.20 | $2,192.00 | $928.00 – $2,679.00 | 3 |
| G-tube reposition CPT 43761 | $361.80 | $603.00 | $205.02 – $280.32 | 3 |
| Guided cath fluid drainage 10030 CPT 10030 | $739.80 | $1,233.00 | $900.09 – $2,679.00 | 3 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $4,200.60 | $7,001.00 | $2,380.34 – $5,110.73 | 3 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $4,939.20 | $8,232.00 | $2.72 – $5.84 | 3 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $695.40 | $1,159.00 | $38.42 – $82.49 | 3 |
| Gw stiffened micro access kit HCPCS C1894 | $1,428.60 | $2,381.00 | $6.46 – $13.87 | 3 |
| Gynecomastia (males) 19300 CPT 19300 | $972.60 | $1,621.00 | $928.00 – $2,679.00 | 3 |
| Hair removal by electrolysis 17380 CPT 17380 | $112.80 | $188.00 | $137.24 – $2,679.00 | 3 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $103.60 | $172.67 | $54.32 – $116.62 | 3 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $32.08 | $53.47 | $9.30 – $19.96 | 3 |
| Hand-held pefr meter a4614 HCPCS A4614 | $2.40 | $4.00 | $2.92 – $2,679.00 | 3 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $16.80 | $28.00 | $20.44 – $2,679.00 | 3 |
| Hand orthosis metacarpal fracture orthosis prefa l3918 HCPCS L3918 | $75.60 | $126.00 | $91.98 – $2,679.00 | 3 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $92.40 | $154.00 | $52.36 – $62.05 | 3 |
| Hand X-ray CPT 73130 | $264.60 | $441.00 | $59.86 – $99.96 | 3 |
| Hand X-ray (2 views, both hands) CPT 73120 | $210.60 | $351.00 | $50.37 – $79.90 | 3 |
| Haptoglobin quantitative CPT 83010 | $130.20 | $217.00 | $22.44 – $48.18 | 3 |
| Harvest cultured skin graft 15040 CPT 15040 | $484.20 | $807.00 | $589.11 – $2,679.00 | 3 |
| Harvest femoropopliteal vein 35572 CPT 35572 | $688.20 | $1,147.00 | $837.31 – $2,679.00 | 3 |
| Harvest vein for bypass 35500 CPT 35500 | $493.80 | $823.00 | $600.79 – $2,679.00 | 3 |
| Hcg qualitative CPT 84703 | $66.00 | $110.00 | $29.92 – $64.24 | 3 |
| Hcg quantitative CPT 84702 | $95.40 | $159.00 | $27.54 – $59.13 | 3 |
| Hc metata joint dislocation anes CPT 28635 | $248.40 | $414.00 | $302.22 – $2,679.00 | 3 |
| Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks CPT 17311 | $1,000.20 | $1,667.00 | $928.00 – $2,679.00 | 3 |
| Hc mohs micrographic h/n/h/f/g each addl stage CPT 17312 | $606.60 | $1,011.00 | $738.03 – $2,679.00 | 3 |
| Hc mohs trunk/arm/leg 1st stage 5 blocks CPT 17313 | $939.60 | $1,566.00 | $928.00 – $2,679.00 | 3 |
| Hc mohs trunk/arm/leg ea addl block any stage CPT 17315 | $116.40 | $194.00 | $141.62 – $2,679.00 | 3 |
| Hc mohs trunk/arm/leg ea stage after 1st stage CPT 17314 | $581.40 | $969.00 | $707.37 – $2,679.00 | 3 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | $202.80 | $338.00 | $246.74 – $2,679.00 | 3 |
| Head CT scan (with and without contrast) CPT 70470 | $1,509.00 | $2,515.00 | $855.10 – $1,835.95 | 3 |
| Head CT scan (with contrast) CPT 70460 | $1,263.60 | $2,106.00 | $716.04 – $1,537.38 | 3 |
| Head CT scan (without contrast) CPT 70450 | $1,198.80 | $1,998.00 | $679.32 – $1,458.54 | 3 |
| Heart tmr w/other procedure 33141 CPT 33141 | $362.40 | $604.00 | $440.92 – $2,679.00 | 3 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $259.20 | $432.00 | $51.83 – $97.92 | 3 |
| Helicobacter pylori antibody igm CPT 86677 | $194.40 | $324.00 | $24.14 – $51.83 | 3 |
| Hematocrit CPT 85014 | $28.80 | $48.00 | $4.76 – $10.22 | 3 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $8,881.19 | $14,801.99 | $5,032.68 – $10,805.45 | 3 |
| Hemoglobin CPT 85018 | $28.80 | $48.00 | $4.76 – $10.22 | 3 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $76.80 | $128.00 | $20.06 – $43.07 | 3 |
| Hemoglobin plasma CPT 83051 | $27.00 | $45.00 | $15.30 – $32.85 | 3 |
| Hemolysins and agglutinins incubated CPT 86941 | $87.00 | $145.00 | $49.30 – $105.85 | 3 |
| Hemorrhoidectomy intern transanal deater 2+ 46948 CPT 46948 | $719.40 | $1,199.00 | $875.27 – $2,679.00 | 3 |
| Hemorrhoidectomy intrnl lig rbbr band ligations CPT 46221 | $501.60 | $836.00 | $610.28 – $2,679.00 | 3 |
| Hemorrhoidopexy stapling 46947 CPT 46947 | $718.80 | $1,198.00 | $874.54 – $2,679.00 | 3 |
| Heparin assay CPT 85520 | $136.20 | $227.00 | $23.80 – $51.10 | 3 |
| Heparin bolus from bag HCPCS J1644 | $84.16 | $140.26 | $7.04 – $15.11 | 3 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $33.24 | $55.40 | $7.60 – $16.32 | 3 |
| Hepatectomy removal of liver 47120 CPT 47120 | $4,363.20 | $7,272.00 | $928.00 – $5,308.56 | 3 |
| Hepatitis a antibody igm CPT 86709 | $93.00 | $155.00 | $21.42 – $45.99 | 3 |
| Hepatitis b core antibody igm CPT 86705 | $42.60 | $71.00 | $23.46 – $50.37 | 3 |
| Hepatitis b core antibody total CPT 86704 | $102.60 | $171.00 | $23.12 – $49.64 | 3 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $1,209.28 | $2,015.46 | $145.08 – $311.49 | 3 |
| Hepatitis b surface antibody CPT 86706 | $121.20 | $202.00 | $9.52 – $20.44 | 3 |
| Hepatitis b vaccine 40 mcg/ml inj-adult CPT 90747 | $343.26 | $572.10 | $194.51 – $417.63 | 3 |
| Hepatitis c antibody CPT 86803 | $195.60 | $326.00 | $20.40 – $43.80 | 3 |
| Hernia Repair (Inguinal) CPT 49505 | $977.40 | $1,629.00 | $383.98 – $2,679.00 | 3 |
| Herpes simplex type 1 antibody igg CPT 86695 | $49.20 | $82.00 | $19.04 – $40.88 | 3 |
| Herpes simplex type 2 antibody igg CPT 86696 | $75.00 | $125.00 | $27.54 – $59.13 | 3 |
| Herpes simplex virus isolation CPT 87255 | $120.00 | $200.00 | $65.96 – $141.62 | 3 |
| Heterophile antibodies screening CPT 86308 | $28.20 | $47.00 | $15.98 – $27.74 | 3 |
| Heterophile antibodies titer CPT 86309 | $33.00 | $55.00 | $18.70 – $40.15 | 3 |
| Hfo nontorsion jnts pre ots HCPCS L3930 | $24.60 | $41.00 | $29.93 – $2,679.00 | 3 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $232.80 | $388.00 | $90.52 – $131.92 | 3 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $393.60 | $656.00 | $91.98 – $172.72 | 3 |
| Hip and Pelvis X-ray (single view, left side) CPT 73501 | $264.60 | $441.00 | $36.50 – $97.24 | 3 |
| Hip X-ray CPT 73502 | $309.60 | $516.00 | $67.16 – $175.44 | 3 |
| Histamine CPT 83088 | $108.60 | $181.00 | $42.16 – $90.52 | 3 |
| HIV 2 pcr qual - sendout CPT 87537 | $454.80 | $758.00 | $257.72 – $553.34 | 3 |
| HIV prep, inj, cabotegravir HCPCS J0739 | $7,320.13 | $12,200.21 | $4,148.07 – $8,906.15 | 3 |
| Hla i low res one antigen equiv ea CPT 81374 | $243.00 | $405.00 | $137.70 – $295.65 | 3 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $324.60 | $541.00 | $183.94 – $394.93 | 3 |
| Hla i typing low res one locus ea CPT 81373 | $393.00 | $655.00 | $173.40 – $372.30 | 3 |
| Hocm 200-249mg/ml iodine,1ml HCPCS Q9960 | $495.88 | $826.46 | $281.00 – $603.32 | 3 |
| Hocm 250-299mg/ml iodine,1ml HCPCS Q9961 | $56.73 | $94.55 | $29.01 – $62.29 | 3 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | $153.04 | $255.06 | $48.40 – $103.91 | 3 |
| Home health re-certification physician g0179 HCPCS G0179 | $66.60 | $111.00 | $81.03 – $2,679.00 | 3 |
| Home/res vst est high mdm 60 CPT 99350 | $343.20 | $572.00 | $417.56 – $2,679.00 | 3 |
| Home/res vst est mod mdm 40 CPT 99349 | $247.20 | $412.00 | $300.76 – $2,679.00 | 3 |
| Home/res vst est sf mdm 20 CPT 99347 | $109.80 | $183.00 | $133.59 – $2,679.00 | 3 |
| Home/res vst new high mdm 75 CPT 99345 | $423.60 | $706.00 | $515.38 – $2,679.00 | 3 |
| Home/res vst new low mdm 30 CPT 99342 | $157.80 | $263.00 | $191.99 – $2,679.00 | 3 |
| Home/res vst new mod mdm 60 CPT 99344 | $353.40 | $589.00 | $429.97 – $2,679.00 | 3 |
| Home/res vst new sf mdm 15 CPT 99341 | $109.20 | $182.00 | $132.86 – $2,679.00 | 3 |
| Home visit est patient 99348 CPT 99348 | $164.40 | $274.00 | $200.02 – $2,679.00 | 3 |
| Home visit new patient CPT 99343 | $258.60 | $431.00 | $314.63 – $2,679.00 | 3 |
| Homocysteine CPT 83090 | $216.00 | $360.00 | $32.30 – $69.35 | 3 |
| Homogenization tissue CPT 87176 | $43.80 | $73.00 | $15.64 – $33.58 | 3 |
| Homovanillic acid (hva) CPT 83150 | $57.00 | $95.00 | $32.30 – $69.35 | 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.