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 |
|---|---|---|---|---|
| Sickling rbc CPT 85660 | $50.70 | $78.00 | $29.48 – $87.80 | 40 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $651.10 | $651.10 | $135.97 – $732.88 | 111 |
| Sinus CT scan (with contrast) CPT 70487 | $2,102.10 | $3,234.00 | $1,222.45 – $3,640.19 | 40 |
| Sinus CT scan (without contrast) CPT 70486 | $1,275.30 | $1,962.00 | $741.64 – $2,208.43 | 40 |
| Sirolimus-protein bound 100 mg intravenous suspension HCPCS J9331 | $42,938.50 | $42,938.50 | $9,250.00 – $48,331.58 | 111 |
| Sleeve fing rolyan med HCPCS L3933 | $37.65 | $57.93 | $21.90 – $65.21 | 40 |
| Sleeve irr assura 1pc disp HCPCS A4397 | $0.65 | $1.00 | $0.38 – $1.13 | 40 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $529.06 | $813.94 | $0.82 – $2.43 | 40 |
| Sling pelv split sam med HCPCS L0621 | $165.55 | $254.70 | $96.28 – $286.69 | 40 |
| Sling suprapubic suburetheral HCPCS C1771 | $9,679.96 | $14,892.24 | $771.78 – $2,298.19 | 40 |
| Sm-153 lexidron ther HCPCS A9604 | $57,456.00 | $57,456.00 | $4,314.91 – $64,672.47 | 111 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $50.70 | $78.00 | $5.34 – $87.80 | 40 |
| Smear gram stain CPT 87205 | $35.75 | $55.00 | $20.79 – $61.91 | 26 |
| Smear nasal eosinophil CPT 89190 | $37.05 | $57.00 | $21.55 – $64.16 | 40 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $64.35 | $99.00 | $5.87 – $99.00 | 40 |
| Smear wet mount CPT 87210 | $41.60 | $64.00 | $24.19 – $72.04 | 40 |
| Sock wool above knee HCPCS L8430 | $158.68 | $244.12 | $92.28 – $274.78 | 40 |
| Sodium 24 hour urine CPT 84300 | $74.10 | $114.00 | $6.73 – $114.00 | 40 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $25.00 | $25.00 | $4.91 – $14.63 | 40 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $22.50 | $22.50 | $6.62 – $19.70 | 40 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $20.00 | $20.00 | $4.35 – $12.94 | 40 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $30.00 | $30.00 | $11.34 – $75.00 | 111 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $292.60 | $292.60 | $10.90 – $45.98 | 111 |
| Sodium serum/plasma/whole blood CPT 84295 | $39.65 | $61.00 | $4.71 – $61.00 | 40 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $495.00 | $495.00 | $105.00 – $557.17 | 111 |
| Specific gravity body fluid CPT 84315 | $30.55 | $47.00 | $17.77 – $52.90 | 40 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $428.35 | $659.00 | $249.10 – $741.77 | 40 |
| Speech Therapy Session (one-on-one) CPT 92507 | $245.70 | $378.00 | $142.88 – $425.48 | 40 |
| Splint arm vnyl coated padded lft med HCPCS Q4051 | $16.25 | $25.00 | $9.45 – $28.14 | 40 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $43.09 | $66.30 | $11.04 – $32.87 | 40 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $50.38 | $77.51 | $14.93 – $44.46 | 40 |
| Splint finger 4 prong foam sm HCPCS A4570 | $0.55 | $0.85 | $0.25 – $0.75 | 40 |
| Splint finger fold over sm HCPCS L3924 | $0.44 | $0.67 | $0.25 – $0.75 | 40 |
| Splint finger frog med HCPCS L3927 | $0.54 | $0.83 | $0.15 – $0.44 | 40 |
| Splint fing stax assort 1-7in HCPCS Q4049 | $1.04 | $1.60 | $0.60 – $1.80 | 40 |
| Splint func pos polyflex ii med HCPCS L3999 | $33.60 | $51.70 | $19.54 – $58.19 | 40 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $101.18 | $155.66 | $18.28 – $54.42 | 40 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $40,862.00 | $40,862.00 | $15,000.00 – $45,994.27 | 111 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $286.65 | $441.00 | $166.70 – $496.39 | 40 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $32,403.15 | $49,851.00 | $0.01 – $12.32 | 40 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $6,063.30 | $9,328.16 | $11.25 – $33.49 | 40 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $18,714.49 | $28,791.53 | $0.88 – $2.61 | 40 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $4,918.86 | $7,567.48 | $318.65 – $948.88 | 40 |
| St evaluate speech sound production CPT 92522 | $336.70 | $518.00 | $195.80 – $583.06 | 40 |
| Strap chin dlx f/cpap HCPCS A7036 | $34.90 | $53.70 | $20.30 – $60.44 | 40 |
| Strap montgmry ns 8 hl sht 7.25 x 11.25in HCPCS A4461 | $0.25 | $0.39 | $0.15 – $0.44 | 40 |
| Strep b dna amp probe CPT 87653 | $145.60 | $224.00 | $84.67 – $252.13 | 40 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $23.00 | $23.00 | $8.69 – $25.89 | 40 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $17.70 | $17.70 | $6.69 – $49.00 | 111 |
| Support clav 29.6-40.5in med HCPCS L3650 | $94.19 | $144.91 | $1.23 – $3.67 | 40 |
| Surgical pathology level 1 gross examination only CPT 88300 | $72.15 | $111.00 | $41.96 – $124.94 | 40 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $116.35 | $179.00 | $67.66 – $201.48 | 40 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $122.20 | $188.00 | $71.06 – $211.61 | 39 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $265.00 | $274.00 | $22.37 – $308.41 | 781 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $321.10 | $494.00 | $186.73 – $556.05 | 40 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $531.05 | $817.00 | $308.83 – $919.62 | 40 |
| Susceptibility mic per plate CPT 87186 | $89.70 | $138.00 | $8.99 – $155.33 | 40 |
| Swallowing Evaluation (Bedside) CPT 92610 | $293.15 | $451.00 | $170.48 – $507.65 | 40 |
| Swallowing Therapy Session CPT 92526 | $221.00 | $340.00 | $128.52 – $382.70 | 40 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $21.45 | $33.00 | $4.31 – $33.00 | 40 |
| System cardiomems hosp electronics HCPCS C2624 | $24,023.02 | $36,958.50 | $5,978.66 – $17,803.11 | 40 |
| System pacing micra av HCPCS C1786 | $16,760.25 | $25,785.00 | $42.96 – $87.25 | 40 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $27,099.09 | $41,690.91 | $60.95 – $123.77 | 40 |
| System recell skin grafting/harvesting HCPCS C1832 | $8,955.20 | $13,777.23 | $5,207.79 – $15,507.65 | 40 |
| System sealant biosentry tract HCPCS C2613 | $652.35 | $1,003.62 | $379.37 – $1,129.67 | 40 |
| T3 (triiodothyronine) free CPT 84481 | $122.20 | $188.00 | $71.06 – $211.61 | 40 |
| T3 (triiodothyronine) total CPT 84480 | $96.85 | $149.00 | $56.32 – $167.71 | 40 |
| T4 (thyroxine) free CPT 84439 | $78.65 | $121.00 | $45.74 – $136.20 | 40 |
| T4 (thyroxine) total CPT 84436 | $52.65 | $81.00 | $6.73 – $81.00 | 40 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $170.70 | $170.70 | $0.15 – $1.13 | 111 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $1,208.10 | $1,208.10 | $262.23 – $1,359.84 | 111 |
| Tacrolimus therapeutic drug level CPT 80197 | $158.60 | $244.00 | $92.23 – $274.65 | 40 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | $4,272.00 | $4,272.00 | $1,540.00 – $4,808.56 | 111 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $221.65 | $341.00 | $128.90 – $383.83 | 40 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | $88,021.00 | $88,021.00 | $321.96 – $990.92 | 111 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | $35,941.50 | $35,941.50 | $868.80 – $5,057.04 | 111 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | $3.02 | $4.64 | $1.75 – $4.64 | 32 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $46,350.00 | $46,350.00 | $1,715.37 – $5,217.16 | 111 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $463.10 | $463.10 | $90.00 – $325.75 | 111 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $221.65 | $341.00 | $98.00 – $341.00 | 40 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $164.45 | $253.00 | $95.63 – $284.78 | 40 |
| Tc-99m apcitide diag HCPCS A9504 | $1,765.30 | $1,765.30 | $667.28 – $1,987.02 | 40 |
| Tc-99m arcitumomab HCPCS A9568 | $4,224.15 | $4,224.15 | $1,596.73 – $4,754.70 | 40 |
| Tc-99m bicisate HCPCS A9557 | $7,128.20 | $7,128.20 | $2,694.46 – $8,023.50 | 40 |
| Tc-99m depreotide HCPCS A9536 | $1,937.35 | $1,937.35 | $732.32 – $2,180.68 | 40 |
| Tc-99m diag per dose HCPCS A4641 | $575.50 | $575.50 | $217.54 – $647.78 | 40 |
| Tc-99m disofenin HCPCS A9510 | $339.80 | $339.80 | $128.44 – $382.48 | 40 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $8,194.15 | $8,194.15 | $3,097.39 – $9,223.34 | 40 |
| Tc-99m exametazime diag HCPCS A9521 | $7,382.05 | $7,382.05 | $2,790.41 – $8,309.24 | 40 |
| Tc-99m fanolesomab diag HCPCS A9566 | $17,688.75 | $17,688.75 | $6,686.35 – $19,910.46 | 40 |
| Tc-99m gluceptate HCPCS A9550 | $1,105.40 | $1,105.40 | $417.84 – $1,244.24 | 40 |
| Tc-99m labeled rbc HCPCS A9560 | $857.40 | $857.40 | $324.10 – $965.09 | 40 |
| Tc-99m maa HCPCS A9540 | $760.95 | $760.95 | $287.64 – $856.53 | 40 |
| Tc-99m mebrofenin HCPCS A9537 | $308.25 | $308.25 | $116.52 – $346.97 | 40 |
| Tc-99m medronate HCPCS A9503 | $210.35 | $210.35 | $79.51 – $236.77 | 40 |
| Tc-99m mertiatide HCPCS A9562 | $1,340.90 | $1,340.90 | $506.86 – $1,509.32 | 40 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $1.00 | $1.00 | $0.38 – $1.13 | 40 |
| Tc-99m oxidronate HCPCS A9561 | $199.60 | $199.60 | $75.45 – $224.67 | 40 |
| Tc-99m pentetate dtpa HCPCS A9539 | $627.25 | $627.25 | $237.10 – $706.03 | 40 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $627.25 | $627.25 | $237.10 – $706.03 | 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.