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 |
|---|---|---|---|---|
| Paste skin barrier .5oz adapt HCPCS A4406 | $0.38 | $0.59 | $0.22 – $0.59 | 32 |
| Pd hl 3.5in 4d med rbr mld 6432 HCPCS L3350 | $94.19 | $144.91 | $54.78 – $163.11 | 40 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | $17,709.85 | $17,709.85 | $700.80 – $19,934.21 | 111 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | $10,830.70 | $10,830.70 | $1,584.48 – $12,191.04 | 111 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | $20,144.40 | $20,144.40 | $1,632.48 – $22,674.54 | 111 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | $11,866.15 | $11,866.15 | $2,749.32 – $13,356.54 | 111 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | $5,037.30 | $5,037.30 | $1,244.52 – $5,669.98 | 111 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | $11,497.50 | $11,497.50 | $1,790.52 – $12,941.59 | 111 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | $95,364.75 | $95,364.75 | $29,110.88 – $107,342.56 | 111 |
| Pelvic CT scan (with contrast) CPT 72193 | $1,740.05 | $2,677.00 | $1,011.91 – $3,013.23 | 40 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,290.90 | $1,986.00 | $750.71 – $2,235.44 | 40 |
| Pelvis X-ray (1 to 2 views) CPT 72170 | $226.85 | $349.00 | $131.92 – $392.83 | 40 |
| Pelvis X-ray (complete, 4 or more views) CPT 72190 | $505.05 | $777.00 | $293.71 – $874.59 | 40 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | $18,047.05 | $18,047.05 | $6,409.00 – $20,313.76 | 111 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | $5,906.25 | $5,906.25 | $40.90 – $1,329.62 | 111 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $1,928.25 | $1,928.25 | $175.80 – $1,253.19 | 111 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $234.00 | $234.00 | $0.88 – $3.66 | 111 |
| Penile rear tip xtnd 0.5cm HCPCS C2622 | $13,529.89 | $20,815.21 | $18.90 – $56.28 | 40 |
| Pentamidine 300 mg solution for injection HCPCS J2516 | $792.75 | $792.75 | $299.66 – $892.32 | 40 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | $14,509.25 | $14,509.25 | $2,783.88 – $16,331.61 | 111 |
| Peripheral vascular rehab CPT 93668 | $273.00 | $420.00 | $158.76 – $472.75 | 40 |
| Perphenazine 4mg oral HCPCS Q0175 | $1.00 | $1.00 | $0.38 – $1.13 | 111 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | $20,666.10 | $20,666.10 | $7,765.80 – $23,261.76 | 111 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $96.38 | $148.28 | $42.04 – $125.18 | 40 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $54,744.57 | $84,222.41 | $0.01 – $0.01 | 40 |
| Ph body fluid CPT 83986 | $52.65 | $81.00 | $3.51 – $41.00 | 40 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $201.80 | $201.80 | $24.74 – $73.67 | 111 |
| Phenobarbital therapeutic drug level CPT 80184 | $120.90 | $186.00 | $15.61 – $209.36 | 40 |
| Phentolaine mesylate inj HCPCS J2760 | $2,253.40 | $2,253.40 | $436.51 – $2,536.43 | 111 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $11.90 | $11.90 | $1.13 – $3.38 | 40 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $8.25 | $8.25 | $0.66 – $3.38 | 111 |
| Phenytoin total therapeutic drug level CPT 80185 | $100.10 | $154.00 | $58.21 – $173.34 | 40 |
| Phosphorus CPT 84100 | $52.00 | $80.00 | $30.24 – $90.05 | 40 |
| Phosphorus 24 hour urine CPT 84105 | $76.05 | $117.00 | $44.23 – $131.70 | 40 |
| Physical Therapy Evaluation (high complexity) CPT 97163 | $196.95 | $303.00 | $114.53 – $341.06 | 40 |
| Physical Therapy Evaluation (low complexity) CPT 97161 | $222.95 | $343.00 | $129.65 – $386.08 | 40 |
| Physical Therapy Evaluation (moderate complexity) CPT 97162 | $194.35 | $299.00 | $113.02 – $336.55 | 40 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $22.60 | $22.60 | $2.84 – $22.29 | 111 |
| Pillow shldr abduc inflat univ HCPCS L3960 | $781.90 | $1,202.93 | $70.44 – $209.77 | 40 |
| Pin caspar distraction 12mm HCPCS C1821 | $24,304.88 | $37,392.12 | $0.01 – $0.43 | 40 |
| Pinworm exam CPT 87172 | $33.80 | $52.00 | $4.18 – $52.00 | 40 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $89.80 | $89.80 | $2.22 – $6.70 | 111 |
| Plasma cryoprecipitate reduced each unit HCPCS P9044 | $247.65 | $381.00 | $144.02 – $428.85 | 40 |
| Platelet aggregation each agent teg CPT 85576 | $134.55 | $207.00 | $78.25 – $233.00 | 40 |
| Platelet automated CPT 85049 | $32.50 | $50.00 | $4.39 – $50.00 | 40 |
| Platelets hla matched leukocytes reduced apheresis/pheresis each unit HCPCS P9052 | $1,504.10 | $2,314.00 | $874.69 – $2,604.64 | 40 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $245.05 | $377.00 | $142.51 – $424.35 | 40 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $397.15 | $611.00 | $230.96 – $687.74 | 40 |
| Platelets leukoreduced cmv negative apheresis/phresis each unit HCPCS P9055 | $1,001.00 | $1,540.00 | $582.12 – $1,733.42 | 40 |
| Platelets pheresis leukocytes reduced cmv negative irradiated each unit HCPCS P9053 | $1,170.65 | $1,801.00 | $680.78 – $2,027.21 | 40 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $953.55 | $1,467.00 | $554.53 – $1,651.26 | 40 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $1,231.75 | $1,895.00 | $716.31 – $2,133.01 | 40 |
| Platelets pheresis pathogen-reduced each unit HCPCS P9073 | $1,053.00 | $1,620.00 | $612.36 – $1,823.47 | 40 |
| Plug insert indwelling 16f HCPCS L8511 | $153.33 | $235.90 | $89.17 – $265.53 | 40 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $220.35 | $339.00 | $96.01 – $285.90 | 40 |
| Polatuzumab vedotin-piiq 140 mg intravenous solution HCPCS J9309 | $59,184.30 | $59,184.30 | $4,472.40 – $14,275.31 | 111 |
| Positioner proc acufex leg acs HCPCS E0190 | $197.14 | $303.30 | $114.65 – $341.39 | 40 |
| Potassium 24 hour urine CPT 84133 | $53.95 | $83.00 | $4.64 – $83.00 | 40 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $60.00 | $60.00 | $0.17 – $3.38 | 111 |
| Potassium serum/plasma/whole blood CPT 84132 | $43.55 | $67.00 | $25.33 – $75.42 | 40 |
| Pouch high output 2pc 50mm red HCPCS A4413 | $282.29 | $434.29 | $164.16 – $434.29 | 32 |
| Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp HCPCS A4388 | $0.28 | $0.43 | $0.16 – $0.48 | 40 |
| Pouch ostmy nb pouchkin ctf HCPCS A5062 | $0.38 | $0.59 | $0.18 – $0.53 | 40 |
| Pouch uros new (both sides) 2.75in clr HCPCS A4432 | $67.84 | $104.37 | $0.19 – $0.49 | 32 |
| Powder prem protct 1oz HCPCS A4371 | $0.45 | $0.70 | $0.26 – $0.79 | 40 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | $411.85 | $411.85 | $86.70 – $463.58 | 111 |
| Pr application splint static short arm CPT 29125 | $325.00 | $500.00 | $10.08 – $374.82 | 781 |
| Pr discharge day management hospital ip/obs <=30 min on ecounter date CPT 99238 | $156.00 | $240.00 | $90.72 – $270.14 | 40 |
| Pr discharge day management hospital ip/obs > 30 min on encounter date CPT 99239 | $166.40 | $256.00 | $96.77 – $288.15 | 40 |
| Prealbumin CPT 84134 | $73.45 | $113.00 | $14.30 – $113.00 | 40 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $151.70 | $151.70 | $38.61 – $170.75 | 111 |
| Prednisone 1 mg tablet HCPCS J7512 | $254.00 | $254.00 | $0.38 – $1.13 | 40 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | $129.35 | $199.00 | $75.22 – $223.99 | 26 |
| Pretreat rbc absorption reference CPT 86978 | $118.95 | $183.00 | $69.17 – $183.00 | 32 |
| Pretreat rbc density gradient separation reference CPT 86972 | $75.40 | $116.00 | $43.85 – $130.57 | 40 |
| Pretreat rbc w chem/drugs reference CPT 86970 | $88.40 | $136.00 | $51.41 – $153.08 | 26 |
| Pretreat rbc w enzyme reference CPT 86971 | $59.80 | $92.00 | $34.78 – $103.56 | 40 |
| Pr hospital ip/obs care initial moderate level per day CPT 99222 | $261.30 | $402.00 | $151.96 – $452.49 | 40 |
| Pr hospital ip/obs care initial straightforward or low level per day CPT 99221 | $180.05 | $277.00 | $104.71 – $311.79 | 40 |
| Pr hospital ip/obs care subsequent straightforward or low level per day CPT 99231 | $74.75 | $115.00 | $43.47 – $129.44 | 40 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $383.00 | $383.00 | $33.48 – $283.00 | 768 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $371.15 | $571.00 | $23.30 – $642.72 | 781 |
| Probe cryo 1150mm endo flex ster disp HCPCS C2618 | $4,097.91 | $6,304.48 | $159.33 – $474.44 | 40 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | $2,889.60 | $2,889.60 | $71.25 – $212.18 | 111 |
| Procalcitonin CPT 84145 | $258.70 | $398.00 | $26.68 – $398.00 | 40 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $24.40 | $24.40 | $2.52 – $27.46 | 111 |
| Prochlorperazine maleate 5 mg tablet HCPCS Q0164 | $1.00 | $1.00 | $0.35 – $1.13 | 111 |
| Progesterone CPT 84144 | $107.25 | $165.00 | $62.37 – $185.72 | 40 |
| Prolactin CPT 84146 | $149.50 | $230.00 | $86.94 – $258.89 | 40 |
| Promethazine 25 mg tablet HCPCS Q0169 | $25.10 | $25.10 | $0.06 – $1.13 | 111 |
| Propofol infusion 10 mg/ml HCPCS J2704 | $46.50 | $46.50 | $4.04 – $12.04 | 40 |
| Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J1800 | $45.50 | $45.50 | $3.48 – $10.36 | 111 |
| Prosthesis voc advantage 20f 14mm HCPCS L8509 | $2,365.32 | $3,638.95 | $0.34 – $1.00 | 40 |
| Prosthesis voc lopres 20f 22mm HCPCS L8507 | $462.69 | $711.83 | $22.96 – $68.36 | 40 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | $150.50 | $150.50 | $8.20 – $56.45 | 111 |
| Protector nerve neurawrap 4cm HCPCS C9353 | $3,580.71 | $5,508.79 | $2,063.50 – $6,144.65 | 40 |
| Protein c activity CPT 85303 | $119.60 | $184.00 | $69.55 – $207.11 | 40 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $74.75 | $115.00 | $43.47 – $129.44 | 40 |
| Protein s total CPT 85305 | $63.05 | $97.00 | $36.67 – $109.18 | 40 |
| Protein total 24 hour urine CPT 84156 | $48.75 | $75.00 | $28.35 – $84.42 | 40 |
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.