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 |
|---|---|---|---|---|
| Protein total body fluid CPT 84157 | $46.15 | $71.00 | $3.96 – $79.92 | 40 |
| Protein total serum plasma whole blood CPT 84155 | $55.25 | $85.00 | $32.13 – $95.68 | 26 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $126.75 | $195.00 | $3.86 – $195.00 | 40 |
| Provox xtraflange 17fr HCPCS L8499 | $84.23 | $129.58 | $39.21 – $116.76 | 40 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $278.20 | $428.00 | $11.76 – $320.80 | 781 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $655.20 | $1,008.00 | $42.32 – $1,134.60 | 781 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $265.00 | $370.00 | $17.36 – $416.47 | 781 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $351.00 | $386.00 | $17.79 – $434.48 | 781 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $256.00 | $309.00 | $14.06 – $347.81 | 781 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $330.00 | $374.00 | $18.32 – $420.97 | 781 |
| Pr visit complexity e&m service serious/complex condition HCPCS G2211 | $27.30 | $42.00 | $15.88 – $47.28 | 40 |
| PSA (Prostate) Test CPT 84153 | $122.20 | $188.00 | $71.06 – $211.61 | 40 |
| Psychotherapy group therapy CPT 90853 | $501.80 | $772.00 | $291.82 – $868.96 | 40 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $396.50 | $610.00 | $230.58 – $686.62 | 40 |
| Psychotherapy patient individual therapy 45 minutes CPT 90834 | $490.75 | $755.00 | $285.39 – $849.83 | 40 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $500.50 | $770.00 | $291.06 – $866.71 | 40 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $102.05 | $157.00 | $59.35 – $176.72 | 40 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $87.75 | $135.00 | $51.03 – $151.96 | 40 |
| Pt application of modality traction mechanical CPT 97012 | $70.85 | $109.00 | $41.20 – $122.69 | 40 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $213.20 | $328.00 | $123.98 – $369.20 | 40 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $74.75 | $115.00 | $43.47 – $129.44 | 40 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $68.90 | $106.00 | $40.07 – $119.31 | 40 |
| Pt wheelchair management each 15 minutes CPT 97542 | $128.70 | $198.00 | $74.84 – $222.87 | 40 |
| Pump on-q 100mlx2ml/hr 2 day delivery HCPCS C9804 | $367.13 | $564.81 | $72.61 – $216.22 | 40 |
| Pyridoxine hcl 100 mg HCPCS J3415 | $19.55 | $19.55 | $7.39 – $22.01 | 111 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | $3,213.80 | $3,213.80 | $532.88 – $3,617.45 | 111 |
| Radium ra223 dichl ther/uci HCPCS A9606 | $507.10 | $507.10 | $169.08 – $570.79 | 111 |
| Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 | $22,849.50 | $22,849.50 | $1,629.60 – $5,143.88 | 111 |
| Rapid Strep Test CPT 87880 | $94.25 | $145.00 | $54.81 – $163.21 | 40 |
| Rasburicase 1.5 mg intravenous solution HCPCS J2783 | $16,770.95 | $16,770.95 | $1,129.44 – $3,775.49 | 111 |
| Ravulizumab-cwvz 100 mg/ml intravenous solution HCPCS J1303 | $73,649.25 | $73,649.25 | $6,755.70 – $22,608.97 | 111 |
| Rbc count only automated CPT 85041 | $18.20 | $28.00 | $10.58 – $31.52 | 40 |
| Rbc deglycerolized each unit HCPCS P9039 | $71.50 | $110.00 | $41.58 – $123.82 | 40 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | $572.00 | $880.00 | $332.64 – $990.53 | 40 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $486.20 | $748.00 | $282.74 – $841.95 | 40 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $425.10 | $654.00 | $247.21 – $736.14 | 40 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $457.60 | $704.00 | $266.11 – $792.42 | 40 |
| Red blood cells washed each unit HCPCS P9022 | $429.00 | $660.00 | $249.48 – $742.90 | 40 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $3,543.15 | $3,543.15 | $673.00 – $3,988.17 | 111 |
| Renal function panel CPT 80069 | $94.25 | $145.00 | $54.81 – $163.21 | 40 |
| Repair rpr lip full thickness vermilion only CPT 40650 | $1,146.00 | $1,146.00 | $79.25 – $1,146.00 | 768 |
| Reslizumab 10 mg/ml intravenous solution HCPCS J2786 | $5,680.00 | $5,680.00 | $2,147.04 – $6,393.41 | 40 |
| Reticulated platelet assay CPT 85055 | $52.00 | $80.00 | $30.24 – $90.05 | 40 |
| Reticulocyte automated CPT 85045 | $47.45 | $73.00 | $27.59 – $82.17 | 40 |
| Reticulocyte direct measurement automated CPT 85046 | $44.85 | $69.00 | $26.08 – $77.67 | 40 |
| Retifanlimab-dlwr 500 mg/20 ml intravenous solution HCPCS J9345 | $45,114.00 | $45,114.00 | $16,405.00 – $50,780.32 | 111 |
| Rezafungin 200 mg intravenous solution HCPCS J0349 | $10,657.15 | $10,657.15 | $2,124.00 – $11,995.69 | 111 |
| Rheumatoid factor qualitative CPT 86430 | $54.60 | $84.00 | $31.75 – $94.55 | 40 |
| Rheumatoid factor quantitative CPT 86431 | $70.20 | $108.00 | $40.82 – $121.56 | 40 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | $294.95 | $294.95 | $74.55 – $332.00 | 111 |
| Rho(d) immune globulin (rhig) human full dose im CPT 90384 | $151.45 | $233.00 | $82.83 – $262.26 | 111 |
| Rib and Chest X-ray (3 views, left side) CPT 71101 | $494.00 | $760.00 | $287.28 – $855.46 | 40 |
| Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr HCPCS J2804 | $82.10 | $82.10 | $9.60 – $92.41 | 111 |
| Ring barrier skin cx 1 9/16 adapt HCPCS A4411 | $0.66 | $1.01 | $0.38 – $1.14 | 40 |
| Ring fx reform 11-13x17mm HCPCS L8610 | $1,052.12 | $1,618.64 | $43.09 – $128.32 | 40 |
| Ring ostmy barr adapt 48mm HCPCS A4385 | $0.33 | $0.51 | $0.19 – $0.57 | 40 |
| Risankizumab-rzaa 60 mg/ml intravenous solution HCPCS J2327 | $30,071.50 | $30,071.50 | $8,904.00 – $33,848.48 | 111 |
| Risperidone microspheres 12.5 mg/2 ml inj HCPCS J2794 | $6,314.65 | $6,314.65 | $1,094.00 – $7,107.77 | 111 |
| Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 | $14,092.80 | $14,092.80 | $830.90 – $3,172.62 | 111 |
| Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln HCPCS J9311 | $22,548.30 | $22,548.30 | $5,663.00 – $22,207.81 | 111 |
| Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 | $12,035.25 | $12,035.25 | $311.80 – $2,709.38 | 111 |
| Rituximab-arrx 10 mg/ml intravenous solution HCPCS Q5123 | $8,300.55 | $8,300.55 | $627.54 – $1,868.66 | 40 |
| Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 | $9,889.65 | $9,889.65 | $265.00 – $2,226.44 | 111 |
| Romidepsin 10 mg/2 ml intravenous powder for solution HCPCS J9319 | $8,826.40 | $8,826.40 | $3,336.38 – $9,935.00 | 111 |
| Romiplostim 125 mcg subcutaneous solution HCPCS J2802 | $17,344.00 | $17,344.00 | $1,375.00 – $4,880.71 | 111 |
| Romosozumab-aqqg 105 mg/1.17 ml subcutaneous syringe (wrapper) HCPCS J3111 | $13,801.85 | $13,801.85 | $2,520.00 – $15,535.36 | 111 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $188.50 | $188.50 | $0.60 – $3.66 | 111 |
| Rozanolixizumab-noli 140 mg/ml subcutaneous solution HCPCS J9333 | $56,796.70 | $56,796.70 | $21,294.00 – $63,930.37 | 111 |
| Rubella antibody igg CPT 86762 | $76.70 | $118.00 | $19.14 – $118.00 | 40 |
| Rubeola antibody igg CPT 86765 | $48.10 | $74.00 | $27.97 – $83.29 | 40 |
| Russell viper venom diluted CPT 85613 | $81.90 | $126.00 | $47.63 – $141.83 | 40 |
| Sacituzumab govitecan-hziy 180 mg intravenous solution HCPCS J9317 | $7,844.35 | $7,844.35 | $2,856.96 – $8,829.60 | 111 |
| Sacroiliac Joint X-ray (3 or more views) CPT 72202 | $222.95 | $343.00 | $129.65 – $386.08 | 40 |
| Sbsq nursing facil care/day minor complj 15 min CPT 99308 | $119.60 | $184.00 | $69.55 – $207.11 | 40 |
| Sbsq nursing facility care/day e/m stable 10 min CPT 99307 | $78.00 | $120.00 | $45.36 – $135.07 | 40 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $735.80 | $1,132.00 | $427.90 – $1,274.18 | 40 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $2,514.76 | $3,868.86 | $685.66 – $2,041.74 | 40 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $5,346.67 | not published | $2.79 – $2.79 | 71 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $661.70 | $1,018.00 | $384.80 – $1,145.86 | 40 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $61.75 | $95.00 | $18.75 – $106.93 | 40 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | $56.55 | $87.00 | $32.89 – $97.93 | 40 |
| Screening hepatitis c antibody high risk HCPCS G0472 | $85.80 | $132.00 | $49.90 – $148.58 | 40 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | $96.85 | $149.00 | $56.32 – $167.71 | 40 |
| Screening Mammogram CPT 77067 | $461.50 | $710.00 | $81.59 – $473.00 | 40 |
| Screening prostate cancer PSA HCPCS G0103 | $129.35 | $199.00 | $75.22 – $223.99 | 40 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $776,558.25 | $1,194,705.00 | $0.01 – $0.09 | 40 |
| Sedation moderate same physician performing a gastrointestinal endoscopic service >= 5 years initial 15 minutes intra-service time HCPCS G0500 | $558.35 | $859.00 | $324.70 – $966.89 | 40 |
| Sedimentation rate erythrocyte automated CPT 85652 | $44.20 | $68.00 | $25.70 – $76.54 | 40 |
| Self-Care and Home Skills Training (each 15 minutes) CPT 97535 | $93.60 | $144.00 | $54.43 – $162.09 | 40 |
| Semen analysis presence/motility CPT 89321 | $100.75 | $155.00 | $58.59 – $174.47 | 40 |
| Sevelamer carbonate 800 mg tablet HCPCS J0601 | $1.50 | $1.50 | $0.40 – $1.69 | 111 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $4,725.71 | $7,270.33 | $276.17 – $822.36 | 40 |
| Sheath laser cavaclear 14f HCPCS C1603 | $5,815.06 | $8,946.25 | $2,513.05 – $7,483.30 | 40 |
| Shoe post-op mens m HCPCS L3260 | $42.87 | $65.95 | $1.10 – $3.26 | 40 |
| Shot (Injection into Muscle or Under the Skin) CPT 96372 | $103.35 | $159.00 | $60.10 – $178.97 | 40 |
| Shoulder X-ray CPT 73030 | $386.10 | $594.00 | $149.69 – $445.74 | 40 |
| Shoulder X-ray (single view, both shoulders) CPT 73020 | $299.65 | $461.00 | $116.05 – $345.56 | 40 |
| Shrinker prosth above knee HCPCS L8460 | $230.16 | $354.09 | $133.85 – $398.56 | 40 |
| Shrinker prosth below knee HCPCS L8440 | $178.39 | $274.45 | $103.74 – $308.92 | 40 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $3,209.23 | $4,937.28 | $67.51 – $201.04 | 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.