MercyOne Dyersville Medical Center
1111 Third St. SW, Dyersville, IA · MercyOne · · NPI 1205816725
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 |
|---|---|---|---|---|
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $7,377.95 | $7,377.95 | $1,112.25 – $8,304.62 | 111 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $1,951.30 | $3,002.00 | $1,134.76 – $3,379.05 | 40 |
| Abdominal CT scan (with contrast) CPT 74160 | $1,591.20 | $2,448.00 | $925.34 – $2,755.47 | 40 |
| Abdominal X-ray (2 views) CPT 74019 | $250.90 | $386.00 | $145.91 – $434.48 | 40 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | $327.60 | $504.00 | $190.51 – $567.30 | 40 |
| Abdominal X-ray (single view) CPT 74018 | $163.15 | $251.00 | $94.88 – $282.53 | 40 |
| Acetaminophen 120 mg rectal suppository HCPCS A9270 | $5,766.93 | $2,532.65 | $0.32 – $3.44 | 111 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $55.20 | $55.20 | $17.23 – $62.13 | 111 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $244.95 | $244.95 | $22.20 – $275.72 | 111 |
| Acute hepatitis panel CPT 80074 | $316.55 | $487.00 | $184.09 – $548.17 | 40 |
| Acyclovir 400 mg tablet HCPCS J8499 | $64.85 | $64.85 | $0.38 – $1.13 | 40 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $10.40 | $10.40 | $0.90 – $4.73 | 111 |
| Adapter b 8 channel 10cm HCPCS C1883 | $19,860.90 | $30,555.23 | $0.01 – $15.10 | 40 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $695.70 | $695.70 | $2.84 – $8.44 | 40 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $78.60 | $78.60 | $0.22 – $1.13 | 111 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $340.60 | $524.00 | $198.07 – $589.81 | 40 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $543.40 | $836.00 | $316.01 – $941.00 | 40 |
| Administration immunization each additional component CPT 90461 | $27.95 | $43.00 | $7.44 – $22.15 | 40 |
| Administration immunization each additional vaccine CPT 90472 | $65.00 | $100.00 | $7.44 – $22.15 | 40 |
| Administration immunization first component each vaccine CPT 90460 | $42.25 | $65.00 | $7.44 – $22.15 | 40 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $46.80 | $72.00 | $7.44 – $22.15 | 40 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $27.95 | $43.00 | $7.44 – $22.15 | 40 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $39.00 | $60.00 | $7.44 – $22.15 | 40 |
| Administration vaccine hepatitis b HCPCS G0010 | $57.20 | $88.00 | $7.44 – $22.15 | 40 |
| Administration vaccine influenza virus HCPCS G0008 | $57.20 | $88.00 | $7.44 – $22.15 | 40 |
| Administration vaccine pneumococcal HCPCS G0009 | $57.20 | $88.00 | $7.44 – $22.15 | 40 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $27.95 | $43.00 | $7.44 – $22.15 | 40 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $19,916.25 | $19,916.25 | $4,580.00 – $14,011.13 | 111 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $18,756.30 | $18,756.30 | $7,089.88 – $21,112.09 | 111 |
| Albumin body fluid quantitative each specimen CPT 82042 | $47.45 | $73.00 | $7.62 – $73.00 | 40 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $871.00 | $871.00 | $329.24 – $980.40 | 40 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $332.50 | $332.50 | $82.22 – $244.82 | 40 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $57.20 | $88.00 | $33.26 – $99.05 | 40 |
| Albumin serum plasma or whole blood CPT 82040 | $57.85 | $89.00 | $33.64 – $100.18 | 40 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $94.90 | $146.00 | $55.19 – $164.34 | 40 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $89,232.75 | $89,232.75 | $29,288.40 – $100,440.38 | 111 |
| Alkaline phosphatase CPT 84075 | $40.95 | $63.00 | $23.81 – $70.91 | 40 |
| Allergen alpha lactalbumin ige CPT 86008 | $31.20 | $48.00 | $17.57 – $48.00 | 40 |
| Allergen egg white ige CPT 86003 | $28.60 | $44.00 | $16.63 – $49.53 | 40 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $43.26 | $66.55 | $25.16 – $74.91 | 40 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $424.66 | $653.33 | $87.63 – $260.94 | 40 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $3,961.09 | $6,093.98 | $43.02 – $128.09 | 40 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $3,663.49 | $5,636.14 | $14.02 – $41.76 | 40 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $159.49 | $245.37 | $10.91 – $32.47 | 40 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $2,097.63 | $3,227.12 | $23.80 – $70.86 | 40 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $238.13 | $366.35 | $75.60 – $225.13 | 40 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $5,609.82 | $8,630.50 | $292.10 – $869.81 | 40 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $232.74 | $358.06 | $130.56 – $388.79 | 40 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $815.54 | $1,254.67 | $227.59 – $677.72 | 40 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $12,452.40 | $12,452.40 | $920.58 – $2,741.29 | 111 |
| Alpha-fetoprotein tumor marker CPT 82105 | $129.35 | $199.00 | $75.22 – $223.99 | 40 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $25,477.05 | $25,477.05 | $94.15 – $297.21 | 110 |
| Alt/sgpt CPT 84460 | $67.60 | $104.00 | $39.31 – $117.06 | 40 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $32.20 | $32.20 | $1.97 – $5.85 | 111 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $33.20 | $33.20 | $7.50 – $30.95 | 111 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $101.15 | $101.15 | $6.94 – $20.65 | 40 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $159.50 | $159.50 | $13.05 – $179.53 | 111 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $73.00 | $73.00 | $2.55 – $10.36 | 111 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $11,933.95 | $11,933.95 | $4,252.50 – $13,432.85 | 111 |
| Ammonia CPT 82140 | $154.70 | $238.00 | $14.42 – $267.89 | 40 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $174.55 | $174.55 | $3.31 – $34.12 | 111 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $1,507.85 | $1,507.85 | $212.57 – $632.98 | 40 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $38.85 | $38.85 | $0.49 – $4.22 | 111 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $14.55 | $14.55 | $2.40 – $7.15 | 111 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $512.85 | $789.00 | $273.19 – $888.10 | 40 |
| Amylase CPT 82150 | $71.50 | $110.00 | $41.58 – $123.82 | 40 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $154.05 | $237.00 | $89.59 – $266.77 | 40 |
| Analysis gene f2 20210g>a variant CPT 81240 | $110.50 | $170.00 | $64.26 – $191.35 | 40 |
| Analysis gene f5 leiden variant CPT 81241 | $379.60 | $584.00 | $220.75 – $657.35 | 40 |
| Anchor suture 3.5mm pushlock HCPCS C1741 | $2,155.00 | $3,315.38 | $636.51 – $1,895.39 | 40 |
| Ankle X-ray CPT 73610 | $407.55 | $627.00 | $158.00 – $470.50 | 40 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $356.20 | $548.00 | $137.97 – $410.84 | 40 |
| Antibody elution rbc reference CPT 86860 | $85.80 | $132.00 | $49.90 – $148.58 | 26 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $257.40 | $396.00 | $149.69 – $445.74 | 40 |
| Antibody id rbc panel CPT 86870 | $291.85 | $449.00 | $169.72 – $505.39 | 40 |
| Antibody screen rbc CPT 86850 | $85.80 | $132.00 | $49.90 – $148.58 | 40 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | $5,144.60 | $5,144.60 | $894.00 – $3,005.86 | 111 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $147.55 | $227.00 | $85.81 – $255.51 | 40 |
| Antinuclear antibodies CPT 86038 | $105.95 | $163.00 | $61.61 – $183.47 | 40 |
| Antistreptolysin o screen CPT 86063 | $48.75 | $75.00 | $28.35 – $84.42 | 40 |
| Antithrombin iii activity CPT 85300 | $135.20 | $208.00 | $78.62 – $234.12 | 40 |
| Antithrombin iii injection HCPCS J7197 | $9,274.05 | $9,274.05 | $2,045.00 – $10,438.87 | 111 |
| Anti-thymocyte glob (equine)(1:1000) intradermal test dose HCPCS J7504 | $14,664.50 | $14,664.50 | $5,013.11 – $16,506.36 | 111 |
| Application of paste boot 29580 CPT 29580 | $465.40 | $716.00 | $180.31 – $536.91 | 40 |
| Applicator tag rfid localizer 12gx7cm HCPCS C1819 | $2,783.02 | $4,281.57 | $1.00 – $2.97 | 40 |
| Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion HCPCS J0185 | $1,185.25 | $1,185.25 | $235.41 – $1,334.12 | 111 |
| Aquatic exercise - group charge CPT 97150 | $33.15 | $51.00 | $19.28 – $57.41 | 40 |
| Arm CT Scan (without contrast, both arms) CPT 73200 | $1,701.70 | $2,618.00 | $659.61 – $1,964.17 | 40 |
| Arsenic trioxide 2 mg/ml intravenous solution HCPCS J9017 | $2,478.30 | $2,478.30 | $76.92 – $2,789.57 | 111 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $103.35 | $159.00 | $40.07 – $119.31 | 40 |
| Ascenda two piece catheter HCPCS C1772 | $15,324.40 | $23,576.00 | $32.67 – $97.30 | 40 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $43.55 | $67.00 | $4.18 – $67.00 | 40 |
| Ast/sgot CPT 84450 | $59.15 | $91.00 | $34.40 – $102.43 | 40 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | $35,811.20 | $35,811.20 | $11,953.20 – $40,309.09 | 111 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $52.65 | $52.65 | $8.26 – $24.59 | 40 |
| Augment injectable kit 3.0cc HCPCS C1734 | $4,652.05 | $7,157.00 | $158.00 – $470.49 | 40 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | $6,470.55 | $6,470.55 | $2,195.20 – $7,283.25 | 111 |
| Azathioprine 50 mg tablet HCPCS J7500 | $66.00 | $66.00 | $1.13 – $3.38 | 111 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $9.20 | $9.20 | $2.61 – $9.85 | 111 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $225.40 | $225.40 | $26.70 – $124.27 | 111 |
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.