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 |
|---|---|---|---|---|
| Unlisted laparoscopic reduction intestine 44238 CPT 44238 | $2,545.20 | $4,242.00 | $928.00 – $3,096.66 | 3 |
| Unlisted laparoscopy procedure biliary tract 47579 CPT 47579 | $1,219.20 | $2,032.00 | $928.00 – $2,679.00 | 3 |
| Unlisted procedure urinary 58750 CPT 58750 | $1,758.60 | $2,931.00 | $928.00 – $2,679.00 | 3 |
| Unlisted psychiatric service/proc 90899 CPT 90899 | $121.20 | $202.00 | $147.46 – $2,679.00 | 3 |
| Unlisted special svc px/rprt CPT 99199 | $9.00 | $15.00 | $5.10 – $10.95 | 3 |
| Unlisted ultrasound procedure CPT 76999 | $157.80 | $263.00 | $115.34 – $2,679.00 | 3 |
| Upgrade pm system CPT 33214 | $932.40 | $1,554.00 | $928.00 – $2,679.00 | 3 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $281.40 | $469.00 | $52.56 – $106.08 | 3 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $1,443.00 | $2,405.00 | $817.70 – $1,755.65 | 3 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,381.20 | $2,302.00 | $782.68 – $1,680.46 | 3 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,361.60 | $3,936.00 | $1,338.24 – $2,873.28 | 3 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $1,275.60 | $2,126.00 | $722.84 – $1,551.98 | 3 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $1,741.80 | $2,903.00 | $987.02 – $2,119.19 | 3 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $223.20 | $372.00 | $58.40 – $126.48 | 3 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $246.00 | $410.00 | $51.83 – $139.40 | 3 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $181.20 | $302.00 | $220.46 – $2,679.00 | 3 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $204.60 | $341.00 | $248.93 – $2,679.00 | 3 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | $504.00 | $840.00 | $613.20 – $2,679.00 | 3 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $363.60 | $606.00 | $206.04 – $442.38 | 3 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $346.80 | $578.00 | $196.52 – $421.94 | 3 |
| Uppr gi scope w/submuc inj CPT 43236 | $661.80 | $1,103.00 | $805.19 – $2,679.00 | 3 |
| Urachal cyst/sinus excision 51500 CPT 51500 | $1,317.60 | $2,196.00 | $928.00 – $2,679.00 | 3 |
| Urea nitrogen CPT 84520 | $34.80 | $58.00 | $15.64 – $33.58 | 3 |
| Urea nitrogen 24 hour urine CPT 84540 | $56.40 | $94.00 | $31.96 – $68.62 | 3 |
| Ureteroneocystostomy 50780 CPT 50780 | $2,313.60 | $3,856.00 | $928.00 – $2,814.88 | 3 |
| Ureteroureterostomy 50760 CPT 50760 | $2,200.20 | $3,667.00 | $928.00 – $2,679.00 | 3 |
| Urethrocystography void s&i CPT 74455 | $480.60 | $801.00 | $272.34 – $584.73 | 3 |
| Uric acid blood CPT 84550 | $31.20 | $52.00 | $9.18 – $19.71 | 3 |
| Uric acid urine CPT 84560 | $32.40 | $54.00 | $9.52 – $20.44 | 3 |
| Urinalysis microscopic only CPT 81015 | $17.40 | $29.00 | $6.80 – $14.60 | 3 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $113.40 | $189.00 | $64.26 – $137.97 | 3 |
| Urinalysis (with microscopy) CPT 81001 | $27.60 | $46.00 | $11.90 – $24.82 | 3 |
| Urinalysis (without microscopy) CPT 81003 | $21.00 | $35.00 | $9.86 – $10.95 | 3 |
| Urine Culture Test CPT 87086 | $47.40 | $79.00 | $24.82 – $53.29 | 3 |
| Urine flow measurement 51736 CPT 51736 | $90.00 | $150.00 | $109.50 – $2,679.00 | 3 |
| Urine pregnancy test CPT 81025 | $52.20 | $87.00 | $20.74 – $21.90 | 3 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $25,816.55 | $43,027.58 | $2,144.24 – $4,603.81 | 3 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $51,633.07 | $86,055.11 | $14,629.38 – $31,410.13 | 3 |
| Vaccine Administration (one shot) CPT 90471 | $52.80 | $88.00 | $5.11 – $28.22 | 3 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $263.57 | $439.29 | $149.36 – $320.68 | 3 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $240.91 | $401.51 | $136.51 – $293.10 | 3 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $274.01 | $456.68 | $155.27 – $333.38 | 3 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $159.71 | $266.19 | $90.50 – $194.32 | 3 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $114.26 | $190.44 | $64.75 – $139.02 | 3 |
| Vaccine dtap < 7 years im CPT 90700 | $66.25 | $110.41 | $36.74 – $78.88 | 3 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $195.95 | $326.59 | $74.25 – $159.42 | 3 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $126.79 | $211.31 | $60.35 – $129.57 | 3 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | $288.65 | $481.08 | $153.41 – $329.39 | 3 |
| Vaccine dtap-ipv/hib im CPT 90698 | $199.37 | $332.29 | $112.98 – $242.57 | 3 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $65.04 | $108.40 | $36.86 – $79.13 | 3 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $63.25 | $105.41 | $20.25 – $43.48 | 3 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $165.01 | $275.02 | $69.62 – $149.47 | 3 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $116.72 | $194.53 | $66.14 – $142.01 | 3 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $144.41 | $240.68 | $46.03 – $98.82 | 3 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $140.37 | $233.95 | $58.98 – $126.63 | 3 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $273.90 | $456.50 | $155.21 – $333.25 | 3 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $64.23 | $107.05 | $27.36 – $58.74 | 3 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $557.26 | $928.76 | $315.78 – $677.99 | 3 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $152.43 | $254.05 | $86.38 – $185.46 | 3 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $142.36 | $237.26 | $80.67 – $173.20 | 3 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $47.38 | $78.97 | $16.22 – $34.83 | 3 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $432.42 | $720.70 | $245.04 – $526.11 | 3 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $354.77 | $591.28 | $201.04 – $431.63 | 3 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $317.02 | $528.36 | $179.64 – $385.70 | 3 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $513.94 | $856.56 | $174.40 – $374.45 | 3 |
| Vaccine mmr live subcutaneous CPT 90707 | $181.04 | $301.73 | $102.59 – $220.26 | 3 |
| Vaccine mmrv live subcutaneous CPT 90710 | $505.10 | $841.83 | $210.19 – $451.29 | 3 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $219.79 | $366.32 | $34.19 – $73.41 | 3 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $424.69 | $707.81 | $233.55 – $501.44 | 3 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $512.71 | $854.52 | $290.54 – $623.80 | 3 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $91.64 | $152.74 | $31.95 – $68.61 | 3 |
| Vaccine rabies im CPT 90675 | $782.20 | $1,303.66 | $179.55 – $385.50 | 3 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $555.82 | $926.37 | $314.97 – $676.25 | 3 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $997.44 | $1,662.40 | $47.45 – $565.22 | 3 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | $997.44 | $1,662.40 | $47.45 – $565.22 | 3 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | $555.02 | $925.04 | $314.51 – $675.28 | 3 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | $263.04 | $438.40 | $140.00 – $300.58 | 3 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $90.16 | $150.26 | $51.09 – $109.69 | 3 |
| Vaccine tdap >=7 years im CPT 90715 | $99.56 | $165.94 | $49.56 – $106.40 | 3 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $83.36 | $138.94 | $35.13 – $75.42 | 3 |
| Vaccine varicella live subcutaneous CPT 90716 | $336.55 | $560.92 | $190.71 – $409.47 | 3 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | $1,993.20 | $3,322.00 | $928.00 – $2,679.00 | 3 |
| Vag hyst incl t/o complex CPT 58291 | $2,430.60 | $4,051.00 | $928.00 – $2,957.23 | 3 |
| Vag hyst including t/o CPT 58262 | $1,797.60 | $2,996.00 | $928.00 – $2,679.00 | 3 |
| Vag hyst t/o & repair compl CPT 58292 | $2,566.80 | $4,278.00 | $928.00 – $3,122.94 | 3 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | $2,378.40 | $3,964.00 | $928.00 – $2,893.72 | 3 |
| Vag hyst w/enterocele repair CPT 58270 | $1,717.80 | $2,863.00 | $928.00 – $2,679.00 | 3 |
| Vag hyst w/uro repair compl 58293 CPT 58293 | $2,667.60 | $4,446.00 | $928.00 – $3,245.58 | 3 |
| Vaginal bx CPT 58999 | $504.00 | $840.00 | $157.68 – $2,679.00 | 3 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | $1,881.00 | $3,135.00 | $928.00 – $2,679.00 | 3 |
| Vaginal Delivery (full care) CPT 59400 | $4,263.60 | $7,106.00 | $928.00 – $5,187.38 | 3 |
| Vaginal hysterectomy CPT 58260 | $1,610.40 | $2,684.00 | $928.00 – $2,679.00 | 3 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | $212.40 | $354.00 | $258.42 – $2,679.00 | 3 |
| Vagotomy & pylorus repair 43640 CPT 43640 | $2,215.20 | $3,692.00 | $928.00 – $2,695.16 | 3 |
| Valproic acid total therapeutic drug level CPT 80164 | $86.40 | $144.00 | $25.84 – $55.48 | 3 |
| Valvuloplasty aortic CPT 92986 | $2,791.20 | $4,652.00 | $928.00 – $3,395.96 | 3 |
| Valvuloplasty mitral CPT 92987 | $2,892.00 | $4,820.00 | $928.00 – $3,518.60 | 3 |
| Valvuloplasty/tv without ring insert 33463 CPT 33463 | $6,010.20 | $10,017.00 | $928.00 – $7,312.41 | 3 |
| Valvuloplasty/tv w/ring insertion 33464 CPT 33464 | $4,753.20 | $7,922.00 | $928.00 – $5,783.06 | 3 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $70.52 | $117.54 | $18.29 – $39.26 | 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.