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 |
|---|---|---|---|---|
| Sleep Study (Polysomnography) CPT 95810 | $3,030.60 | $5,051.00 | $830.74 – $1,717.34 | 3 |
| Sleep study unattended CPT 95806 | $1,183.20 | $1,972.00 | $82.49 – $670.48 | 3 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $16.80 | $28.00 | $2.72 – $5.84 | 3 |
| Sling pelv split sam med HCPCS L0621 | $23.40 | $39.00 | $28.47 – $2,679.00 | 3 |
| Sling suprapubic suburetheral HCPCS C1771 | $3,130.80 | $5,218.00 | $1,272.62 – $2,732.39 | 3 |
| Slp pure tone screening CPT 92551 | $24.00 | $40.00 | $29.20 – $2,679.00 | 3 |
| Small Bowel Barium X-ray (Follow-Through) CPT 74250 | $352.80 | $588.00 | $199.92 – $429.24 | 3 |
| Small bowel endoscopy CPT 44360 | $325.80 | $543.00 | $396.39 – $2,679.00 | 3 |
| Small bowel endoscopy CPT 44364 | $310.20 | $517.00 | $377.41 – $2,679.00 | 3 |
| Small bowel endoscopy CPT 44366 | $369.00 | $615.00 | $448.95 – $2,679.00 | 3 |
| Small bowel endoscopy CPT 44369 | $372.00 | $620.00 | $452.60 – $2,679.00 | 3 |
| Small bowel endoscopy CPT 44376 | $589.20 | $982.00 | $716.86 – $2,679.00 | 3 |
| Small bowel endoscopy CPT 44382 | $307.20 | $512.00 | $373.76 – $2,679.00 | 3 |
| Small bowel endoscopy >2nd w/remove 44363 CPT 44363 | $411.60 | $686.00 | $500.78 – $2,679.00 | 3 |
| Small bowel endoscopy 44365 CPT 44365 | $378.00 | $630.00 | $459.90 – $2,679.00 | 3 |
| Small bowel endoscopy/biopsy CPT 44361 | $312.00 | $520.00 | $379.60 – $2,679.00 | 3 |
| Small bowel endoscopy br/wa CPT 44380 | $253.80 | $423.00 | $308.79 – $2,679.00 | 3 |
| Small bowel endoscopy/stent 44370 CPT 44370 | $405.00 | $675.00 | $492.75 – $2,679.00 | 3 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $150.00 | $250.00 | $10.54 – $22.63 | 3 |
| Smear gram stain CPT 87205 | $48.00 | $80.00 | $17.00 – $36.50 | 3 |
| Smear nasal eosinophil CPT 89190 | $41.40 | $69.00 | $18.70 – $40.15 | 3 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $32.40 | $54.00 | $8.84 – $18.98 | 3 |
| Smear wet mount CPT 87210 | $48.00 | $80.00 | $16.79 – $27.20 | 3 |
| Sodium 24 hour urine CPT 84300 | $45.60 | $76.00 | $9.86 – $21.17 | 3 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $68.74 | $114.57 | $38.95 – $83.64 | 3 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | $432.56 | $720.94 | $137.52 – $295.26 | 3 |
| Sodium serum/plasma/whole blood CPT 84295 | $46.80 | $78.00 | $14.96 – $32.12 | 3 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $170.35 | $283.92 | $96.53 – $207.26 | 3 |
| Spacer bag/reservoir HCPCS A4627 | $6.60 | $11.00 | $8.03 – $2,679.00 | 3 |
| Special casting material HCPCS A4590 | $36.60 | $61.00 | $6.57 – $2,679.00 | 3 |
| Special supplies phys/qhp CPT 99070 | $8.40 | $14.00 | $10.22 – $2,679.00 | 3 |
| Specific gravity body fluid CPT 84315 | $21.00 | $35.00 | $11.90 – $25.55 | 3 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $303.60 | $506.00 | $47.60 – $102.20 | 3 |
| Speech recep thresh CPT 92555 | $41.40 | $69.00 | $50.37 – $2,679.00 | 3 |
| Speech Therapy Session (one-on-one) CPT 92507 | $283.20 | $472.00 | $19.38 – $41.61 | 3 |
| Sperm washing 58323 CPT 58323 | $39.60 | $66.00 | $48.18 – $2,679.00 | 3 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | $1,456.20 | $2,427.00 | $928.00 – $2,679.00 | 3 |
| Spinal bone allograftstructural 20931 CPT 20931 | $243.00 | $405.00 | $295.65 – $2,679.00 | 3 |
| Spinal bone autograftlocal 20936 CPT 20936 | $424.20 | $707.00 | $516.11 – $2,679.00 | 3 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,032.60 | $1,721.00 | $585.14 – $1,256.33 | 3 |
| Spine X-ray (single view, one level) CPT 72020 | $148.20 | $247.00 | $83.98 – $180.31 | 3 |
| Splenectomy total open 38100 CPT 38100 | $2,166.00 | $3,610.00 | $928.00 – $2,679.00 | 3 |
| Splint arm vnyl coated padded lft med HCPCS Q4051 | $48.00 | $80.00 | $58.40 – $2,679.00 | 3 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $36.00 | $60.00 | $11.56 – $24.82 | 3 |
| Splint finger 4 prong foam sm HCPCS A4570 | $16.80 | $28.00 | $20.44 – $2,679.00 | 3 |
| Splint finger frog med HCPCS L3927 | $3.00 | $5.00 | $1.36 – $2.92 | 3 |
| Splint fing stax assort 1-7in HCPCS Q4049 | $3.60 | $6.00 | $4.38 – $2,679.00 | 3 |
| Splint func pos polyflex ii med HCPCS L3999 | $4.80 | $8.00 | $5.84 – $2,679.00 | 3 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $16.20 | $27.00 | $19.71 – $2,679.00 | 3 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $1,651.80 | $2,753.00 | $928.00 – $2,679.00 | 3 |
| Spontaneous nystagmus study CPT 92531 | $52.20 | $87.00 | $63.51 – $2,679.00 | 3 |
| Staging lapro hodgkins disease/lymphoma 49220 CPT 49220 | $1,826.40 | $3,044.00 | $928.00 – $2,679.00 | 3 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $225.60 | $376.00 | $47.60 – $102.20 | 3 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $78.60 | $131.00 | $44.54 – $95.63 | 3 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $1,219.80 | $2,033.00 | $928.00 – $2,679.00 | 3 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $14,157.00 | $23,595.00 | $103.36 – $221.92 | 3 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $691.20 | $1,152.00 | $66.30 – $142.35 | 3 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $11,238.60 | $18,731.00 | $12.92 – $27.74 | 3 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $831.60 | $1,386.00 | $928.00 – $2,679.00 | 3 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $2,378.40 | $3,964.00 | $928.00 – $2,893.72 | 3 |
| Stent placemt retro carotid CPT 37217 | $1,645.20 | $2,742.00 | $928.00 – $2,679.00 | 3 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $1,173.60 | $1,956.00 | $928.00 – $2,679.00 | 3 |
| Stereotactic bx aspir/exc burr intracranial les 61750 CPT 61750 | $2,587.80 | $4,313.00 | $928.00 – $3,148.49 | 3 |
| Sternal debridement CPT 21627 | $1,048.20 | $1,747.00 | $928.00 – $2,679.00 | 3 |
| St evaluate speech sound production CPT 92522 | $225.60 | $376.00 | $47.60 – $102.20 | 3 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $244.80 | $408.00 | $138.72 – $297.84 | 3 |
| Stot/tot hysterectomy after cesaren delivery 59525 CPT 59525 | $1,000.20 | $1,667.00 | $928.00 – $2,679.00 | 3 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $70.80 | $118.00 | $86.14 – $2,679.00 | 3 |
| Strapping of elbow or wrist 29260 CPT 29260 | $99.00 | $165.00 | $120.45 – $2,679.00 | 3 |
| Strapping of toes 29550 CPT 29550 | $60.00 | $100.00 | $73.00 – $2,679.00 | 3 |
| Streptokinase 1.5 m-units inj HCPCS J2995 | $917.47 | $1,529.12 | $123.21 – $264.54 | 3 |
| Streptomycin injection HCPCS J3000 | $150.80 | $251.33 | $85.45 – $183.47 | 3 |
| Streptozocin injection HCPCS J9320 | $270.37 | $450.62 | $153.21 – $328.95 | 3 |
| Stress test pulmonary CPT 94618 | $73.20 | $122.00 | $41.48 – $43.80 | 3 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | $214.20 | $357.00 | $260.61 – $2,679.00 | 3 |
| Subq i/p critical care pr day age 28 days/less than 99469 CPT 99469 | $842.40 | $1,404.00 | $928.00 – $2,679.00 | 3 |
| Subsequent intensive care infant 1500-2500 grams 99479 CPT 99479 | $257.40 | $429.00 | $313.17 – $2,679.00 | 3 |
| Subsequent intensive care infant 2501-5000 grams 99480 CPT 99480 | $242.40 | $404.00 | $294.92 – $2,679.00 | 3 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $46.73 | $77.89 | $9.37 – $20.11 | 3 |
| Suction lipectomy head&neck CPT 15876 | $1,147.20 | $1,912.00 | $928.00 – $2,679.00 | 3 |
| Suction lipectomy lwr extrem CPT 15879 | $1,081.20 | $1,802.00 | $928.00 – $2,679.00 | 3 |
| Suction lipectomy trunk CPT 15877 | $1,081.20 | $1,802.00 | $928.00 – $2,679.00 | 3 |
| Suction lipectomy upr extrem CPT 15878 | $477.60 | $796.00 | $581.08 – $2,679.00 | 3 |
| Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution HCPCS C9399 | $4,374.50 | $7,290.84 | $1,042.03 – $2,237.30 | 3 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $96.23 | $160.39 | $29.37 – $63.05 | 3 |
| Sulfonylurea screen qn-sendout CPT 80377 | $213.60 | $356.00 | $121.04 – $259.88 | 3 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $359.84 | $599.74 | $203.91 – $437.81 | 3 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | $24.00 | $40.00 | $29.20 – $2,679.00 | 3 |
| Support clav 29.6-40.5in med HCPCS L3650 | $86.40 | $144.00 | $8.16 – $17.52 | 3 |
| Surg dx exam anorectal CPT 45990 | $204.60 | $341.00 | $248.93 – $2,679.00 | 3 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | $1,632.60 | $2,721.00 | $928.00 – $2,679.00 | 3 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | $1,634.40 | $2,724.00 | $928.00 – $2,679.00 | 3 |
| Surgical exposure prostate 55860 CPT 55860 | $1,639.80 | $2,733.00 | $928.00 – $2,679.00 | 3 |
| Surgical opening of stomach 43500 CPT 43500 | $1,477.80 | $2,463.00 | $928.00 – $2,679.00 | 3 |
| Surgical pathology level 1 gross examination only CPT 88300 | $30.60 | $51.00 | $17.34 – $37.23 | 3 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $73.80 | $123.00 | $41.82 – $89.79 | 3 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $74.40 | $124.00 | $42.16 – $90.52 | 3 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $71.40 | $119.00 | $36.38 – $78.11 | 3 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $99.00 | $165.00 | $56.10 – $120.45 | 3 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $154.20 | $257.00 | $60.86 – $130.67 | 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.