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 |
|---|---|---|---|---|
| Sacroiliac Joint X-ray (3 or more views) CPT 72202 | $184.80 | $308.00 | $63.51 – $104.72 | 3 |
| Salpingostomy 58770 CPT 58770 | $1,655.40 | $2,759.00 | $928.00 – $2,679.00 | 3 |
| Same day nb discharge 99463 CPT 99463 | $229.20 | $382.00 | $278.86 – $2,679.00 | 3 |
| Sargramostim injection HCPCS J2820 | $463.93 | $773.21 | $134.97 – $289.78 | 3 |
| Sbsq ic vlbw inf<1,500 gm CPT 99478 | $279.60 | $466.00 | $340.18 – $2,679.00 | 3 |
| Sbsq nurs facil care/day unstabl/new prob 35 min 99310 CPT 99310 | $259.20 | $432.00 | $315.36 – $2,679.00 | 3 |
| Sbsq nursing facil care/day minor complj 15 min CPT 99308 | $133.20 | $222.00 | $162.06 – $2,679.00 | 3 |
| Sbsq nursing facil care/day new problem 25 min CPT 99309 | $174.60 | $291.00 | $212.43 – $2,679.00 | 3 |
| Sbsq nursing facility care/day e/m stable 10 min CPT 99307 | $86.40 | $144.00 | $105.12 – $2,679.00 | 3 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $483.00 | $805.00 | $43.07 – $198.22 | 3 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $120.60 | $201.00 | $42.34 – $68.34 | 3 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $327.00 | $545.00 | $397.85 – $2,679.00 | 3 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $472.80 | $788.00 | $24.82 – $267.92 | 3 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $389.40 | $649.00 | $42.34 – $220.66 | 3 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $424.80 | $708.00 | $240.72 – $309.52 | 3 |
| Scan proc cranial intra 61781 CPT 61781 | $436.80 | $728.00 | $531.44 – $2,679.00 | 3 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $1,817.40 | $3,029.00 | $928.00 – $2,679.00 | 3 |
| Scope plantar fasciotomy CPT 29893 | $1,165.80 | $1,943.00 | $928.00 – $2,679.00 | 3 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $3,825.00 | $6,375.00 | $2,167.50 – $4,653.75 | 3 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $643.20 | $1,072.00 | $782.56 – $2,679.00 | 3 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $643.20 | $1,072.00 | $782.56 – $2,679.00 | 3 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $48.00 | $80.00 | $58.40 – $2,679.00 | 3 |
| Screening Mammogram CPT 77067 | $276.60 | $461.00 | $38.42 – $82.49 | 3 |
| Screening prostate cancer PSA HCPCS G0103 | $67.20 | $112.00 | $36.38 – $56.94 | 3 |
| Screen/visual acuity/bilat/quant 99173 CPT 99173 | $8.40 | $14.00 | $10.22 – $2,679.00 | 3 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $37,537.80 | $62,563.00 | $0.34 – $0.73 | 3 |
| Scrotal (Testicle) Ultrasound CPT 76870 | $472.80 | $788.00 | $267.92 – $575.24 | 3 |
| Sec abd wall suture evisceration/dehsn 49900 CPT 49900 | $1,534.80 | $2,558.00 | $928.00 – $2,679.00 | 3 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $2,611.80 | $4,353.00 | $928.00 – $3,177.69 | 3 |
| Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time HCPCS G0500 | $66.00 | $110.00 | $80.30 – $2,679.00 | 3 |
| Sedimentation rate erythrocyte automated CPT 85652 | $18.60 | $31.00 | $10.54 – $22.63 | 3 |
| Segmentectomy 32484 CPT 32484 | $2,782.80 | $4,638.00 | $928.00 – $3,385.74 | 3 |
| Select picture audiometry CPT 92583 | $88.20 | $147.00 | $107.31 – $2,679.00 | 3 |
| Self-Care and Home Skills Training (each 15 minutes) CPT 97535 | $69.60 | $116.00 | $39.44 – $62.05 | 3 |
| Semen analysis presence/motility CPT 89321 | $36.00 | $60.00 | $20.40 – $43.80 | 3 |
| Serial casting application 97139app CPT 97139 | $159.00 | $265.00 | $193.45 – $2,679.00 | 3 |
| Sertraline (zoloft) - sendout CPT 80332 | $208.20 | $347.00 | $117.98 – $253.31 | 3 |
| Sgmdsc w/band ligation CPT 45350 | $1,275.60 | $2,126.00 | $928.00 – $2,679.00 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 0.5cm/< CPT 11310 | $163.20 | $272.00 | $198.56 – $2,679.00 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm CPT 11311 | $204.00 | $340.00 | $248.20 – $2,679.00 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm CPT 11312 | $236.40 | $394.00 | $287.62 – $2,679.00 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m >2cm CPT 11313 | $294.00 | $490.00 | $357.70 – $2,679.00 | 3 |
| Shave sgl skin lsn s/n/h/f/g 0.5cm/< CPT 11305 | $134.40 | $224.00 | $163.52 – $2,679.00 | 3 |
| Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm CPT 11306 | $183.00 | $305.00 | $222.65 – $2,679.00 | 3 |
| Shave sgl skin lsn s/n/h/f/g 1.1-2cm CPT 11307 | $214.20 | $357.00 | $260.61 – $2,679.00 | 3 |
| Shave sgl skin lsn s/n/h/f/g >2cm CPT 11308 | $238.80 | $398.00 | $290.54 – $2,679.00 | 3 |
| Shave sgl skin lsn t/a/l 0.5cm/< CPT 11300 | $133.20 | $222.00 | $162.06 – $2,679.00 | 3 |
| Shave sgl skin lsn t/a/l 0.6-1.0cm CPT 11301 | $178.20 | $297.00 | $216.81 – $2,679.00 | 3 |
| Shave sgl skin lsn t/a/l 1.1-2.0cm CPT 11302 | $213.00 | $355.00 | $259.15 – $2,679.00 | 3 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $7,481.40 | $12,469.00 | $337.96 – $725.62 | 3 |
| Shoe heel pad & depress for HCPCS L3480 | $4.80 | $8.00 | $5.84 – $2,679.00 | 3 |
| Shoe post-op mens m HCPCS L3260 | $21.00 | $35.00 | $3.74 – $8.03 | 3 |
| Sho heel count plast reinfor HCPCS L3430 | $16.20 | $27.00 | $19.71 – $2,679.00 | 3 |
| Shot (Injection into Muscle or Under the Skin) CPT 96372 | $73.20 | $122.00 | $41.48 – $49.64 | 3 |
| Shoulder AC Joint X-ray (both sides) CPT 73050 | $175.20 | $292.00 | $74.46 – $99.28 | 3 |
| Shoulder Blade (Scapula) X-ray (both sides) CPT 73010 | $238.20 | $397.00 | $56.21 – $90.10 | 3 |
| Shoulder MRI (with and without contrast) CPT 73223 | $3,769.80 | $6,283.00 | $1,182.52 – $2,538.94 | 3 |
| Shoulder MRI (with contrast) CPT 73222 | $2,408.40 | $4,014.00 | $909.84 – $1,953.48 | 3 |
| Shoulder MRI (without contrast) CPT 73221 | $2,193.60 | $3,656.00 | $828.24 – $1,778.28 | 3 |
| Shoulder X-ray CPT 73030 | $300.60 | $501.00 | $54.02 – $113.56 | 3 |
| Shoulder X-ray (single view, both shoulders) CPT 73020 | $165.60 | $276.00 | $62.56 – $134.32 | 3 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $4,781.40 | $7,969.00 | $765.00 – $1,642.50 | 3 |
| Sialolithotomy 42330 CPT 42330 | $454.80 | $758.00 | $553.34 – $2,679.00 | 3 |
| Sickling rbc CPT 85660 | $28.20 | $47.00 | $8.16 – $17.52 | 3 |
| Sigmoidoscopy and biopsy CPT 45331 | $105.60 | $176.00 | $128.48 – $2,679.00 | 3 |
| Sigmoidoscopy flex decompression 45337 CPT 45337 | $291.00 | $485.00 | $354.05 – $2,679.00 | 3 |
| Sigmoidoscopy for bleeding CPT 45334 | $741.00 | $1,235.00 | $901.55 – $2,679.00 | 3 |
| Sigmoidoscopy/submucosal injection 45335 CPT 45335 | $541.80 | $903.00 | $659.19 – $2,679.00 | 3 |
| Sigmoidoscopy w/ablation CPT 45346 | $1,464.00 | $2,440.00 | $928.00 – $2,679.00 | 3 |
| Sigmoidoscopy w/fb removal 45332 CPT 45332 | $565.80 | $943.00 | $688.39 – $2,679.00 | 3 |
| Sigmoidoscopy w/plcmt stent CPT 45347 | $318.00 | $530.00 | $386.90 – $2,679.00 | 3 |
| Sigmoidoscopy w/resection CPT 45349 | $301.80 | $503.00 | $367.19 – $2,679.00 | 3 |
| Sigmoidoscopy w/tumr remove CPT 45338 | $622.20 | $1,037.00 | $757.01 – $2,679.00 | 3 |
| Sigmoidoscopy w/ultrasound CPT 45341 | $283.80 | $473.00 | $345.29 – $2,679.00 | 3 |
| Sigmoidoscopy w/us guide bx CPT 45342 | $257.40 | $429.00 | $313.17 – $2,679.00 | 3 |
| Sigmoid/rmv tumor/polyp/hot bx for 45333 CPT 45333 | $574.80 | $958.00 | $699.34 – $2,679.00 | 3 |
| Signal avg ecg w or without ecg 93278 CPT 93278 | $123.60 | $206.00 | $150.38 – $2,679.00 | 3 |
| Sig w/tndsc balloon dilation CPT 45340 | $928.20 | $1,547.00 | $928.00 – $2,679.00 | 3 |
| Simple cystometrogram 51725 CPT 51725 | $381.60 | $636.00 | $464.28 – $2,679.00 | 3 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $243.50 | $405.83 | $137.98 – $296.26 | 3 |
| Sinus CT scan (with and without contrast) CPT 70488 | $1,351.80 | $2,253.00 | $766.02 – $1,644.69 | 3 |
| Sinus CT scan (with contrast) CPT 70487 | $1,342.80 | $2,238.00 | $760.92 – $1,633.74 | 3 |
| Sinus CT scan (without contrast) CPT 70486 | $1,021.80 | $1,703.00 | $579.02 – $1,243.19 | 3 |
| Sinus/juglr venogram s&i CPT 75860 | $919.80 | $1,533.00 | $928.00 – $2,679.00 | 3 |
| Sinusotomy maxillary sinus 31020 CPT 31020 | $937.20 | $1,562.00 | $928.00 – $2,679.00 | 3 |
| Sinusotomy sinus remove polyps 31032 CPT 31032 | $1,110.60 | $1,851.00 | $928.00 – $2,679.00 | 3 |
| Sinusotomy sphenoid w/wo bx 31050 CPT 31050 | $947.40 | $1,579.00 | $928.00 – $2,679.00 | 3 |
| Sinus X-ray (complete) CPT 70220 | $250.20 | $417.00 | $141.78 – $148.19 | 3 |
| Sinus X-ray (limited) CPT 70210 | $207.60 | $346.00 | $90.52 – $117.64 | 3 |
| Sipuleucel-t - su HCPCS Q2043 | $98,900.28 | $164,833.80 | $56,043.49 – $120,328.67 | 3 |
| Sirolimus, oral HCPCS J7520 | $60.62 | $101.04 | $8.19 – $17.59 | 3 |
| Skin Biopsy CPT 11102 | $160.80 | $268.00 | $195.64 – $2,679.00 | 3 |
| Skin full graft 20sq cm less 15200 CPT 15200 | $1,573.20 | $2,622.00 | $928.00 – $2,679.00 | 3 |
| Skin full graft add-on 15241 CPT 15241 | $268.20 | $447.00 | $326.31 – $2,679.00 | 3 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | $354.00 | $590.00 | $430.70 – $2,679.00 | 3 |
| Skin test unlisted antigen ea CPT 86486 | $43.80 | $73.00 | $24.82 – $53.29 | 3 |
| Skull X-ray (1 to 3 views) CPT 70250 | $165.00 | $275.00 | $62.78 – $93.50 | 3 |
| Skull X-ray (complete) CPT 70260 | $273.00 | $455.00 | $154.70 – $332.15 | 3 |
| Skyla, 13.5 mg HCPCS J7301 | $1,801.20 | $3,002.00 | $1,020.68 – $2,191.46 | 3 |
| Sleep study attended CPT 95807 | $1,168.20 | $1,947.00 | $661.98 – $1,421.31 | 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.