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 |
|---|---|---|---|---|
| Ga-68 gallium 68 dotatate HCPCS A9587 | $15,600.00 | $15,600.00 | $5,896.80 – $17,559.36 | 40 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | $591.40 | $591.40 | $19.76 – $665.68 | 40 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | $231.00 | $231.00 | $7.35 – $260.01 | 40 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | $99.80 | $99.80 | $24.00 – $112.33 | 40 |
| Gamma globulin 1 cc inj HCPCS J1460 | $463.20 | $463.20 | $96.84 – $521.38 | 111 |
| Gammaglobulin iga CPT 82784 | $81.90 | $126.00 | $47.63 – $141.83 | 40 |
| Gammaglobulin ige CPT 82785 | $83.85 | $129.00 | $48.76 – $145.20 | 40 |
| Gamma glutamyltransferase CPT 82977 | $60.45 | $93.00 | $35.15 – $104.68 | 40 |
| Gamunex-c/gammaked HCPCS J1561 | $14,238.00 | $14,238.00 | $480.30 – $2,003.29 | 111 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | $314.60 | $314.60 | $31.30 – $93.20 | 111 |
| Gemcitabine 1 gram intravenous solution HCPCS J9201 | $540.20 | $540.20 | $16.20 – $56.45 | 111 |
| Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln HCPCS J9203 | $31,504.65 | $31,504.65 | $11,652.30 – $35,461.63 | 111 |
| Generator barostim neo2 2014 HCPCS C1767 | $44,831.44 | $68,971.44 | $1.27 – $3.78 | 40 |
| Generator emblem MRI sicd subq HCPCS C1722 | $22,347.00 | $34,380.00 | $411.20 – $835.02 | 40 |
| Generator stim baroreceptor neo legacy implant pulse HCPCS C1825 | $37,570.90 | $57,801.38 | $16,894.33 – $50,307.57 | 40 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $17.40 | $17.40 | $1.64 – $4.90 | 40 |
| Gentamicin peak therapeutic drug level CPT 80170 | $97.50 | $150.00 | $56.70 – $168.84 | 40 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $197.42 | $168.00 | $6.74 – $126.07 | 781 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $224.25 | $345.00 | $86.94 – $258.89 | 40 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $547.95 | $843.00 | $318.65 – $948.88 | 40 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $668.85 | $1,029.00 | $388.96 – $1,158.24 | 40 |
| Ghs nailbed repair/nail removal CPT 11760 | $505.05 | $777.00 | $293.71 – $874.59 | 40 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $67.00 | $67.00 | $15.34 – $67.00 | 768 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $485.00 | $581.00 | $28.65 – $653.97 | 781 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $282.10 | $434.00 | $164.05 – $488.51 | 40 |
| Gi inhouse confirmation CPT 87045 | $83.85 | $129.00 | $48.76 – $145.20 | 40 |
| Glove finger flexion right lg xl HCPCS L3912 | $53.03 | $81.59 | $22.10 – $65.81 | 40 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $655.40 | $655.40 | $247.74 – $737.72 | 39 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $567.40 | $567.40 | $214.48 – $638.67 | 40 |
| Glucose 1 hr post dose CPT 82950 | $41.60 | $64.00 | $24.19 – $72.04 | 40 |
| Glucose blood quantitative CPT 82947 | $36.40 | $56.00 | $21.17 – $63.03 | 40 |
| Glucose body fluid CPT 82945 | $45.50 | $70.00 | $3.89 – $78.79 | 40 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $92.30 | $142.00 | $21.62 – $159.84 | 40 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $53.95 | $83.00 | $3.84 – $83.00 | 40 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $7.00 | $7.00 | $2.65 – $7.88 | 40 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $5,516.60 | $5,516.60 | $551.50 – $6,209.48 | 111 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $133.25 | $205.00 | $77.49 – $230.75 | 40 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $135.20 | $208.00 | $78.62 – $234.12 | 40 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $16,064.55 | $16,064.55 | $803.41 – $6,635.52 | 111 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $100.11 | $154.01 | $58.22 – $173.35 | 40 |
| Graft axiofill 1000mg HCPCS J3590 | $6,300.79 | $9,693.53 | $611.82 – $1,821.85 | 40 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | $1.41 | $2.17 | $0.82 – $2.44 | 40 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $1,885.86 | $2,901.33 | $36.39 – $108.37 | 40 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $4,970.86 | $7,647.47 | $0.17 – $0.52 | 40 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $1,548.87 | $2,382.88 | $900.73 – $2,682.17 | 40 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $16,761.06 | $25,786.25 | $0.16 – $0.48 | 40 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $35,755.20 | $55,008.00 | $0.01 – $0.81 | 40 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $304.44 | $468.37 | $0.59 – $1.76 | 40 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $397.50 | $611.54 | $90.23 – $268.68 | 40 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $414.05 | $637.00 | $115.63 – $344.31 | 40 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $476.79 | $733.52 | $30.78 – $91.65 | 40 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | $58.05 | $89.31 | $33.76 – $100.53 | 40 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $1,705.66 | $2,624.09 | $0.02 – $0.06 | 40 |
| Graft viashield 2layer amnion patch 2x2cm-cost per sq cm HCPCS Q4211 | $593.61 | $913.25 | $132.30 – $393.97 | 40 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $312.02 | $480.03 | $23.47 – $69.90 | 40 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $25,506.74 | $39,241.14 | $18.90 – $56.28 | 40 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $17,074.23 | $26,268.04 | $41.34 – $123.10 | 40 |
| Granisetron hcl injection HCPCS J1626 | $92.00 | $92.00 | $2.30 – $12.89 | 111 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $2,547.89 | $3,919.83 | $1,470.89 – $4,379.98 | 40 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $4,925.86 | $7,578.25 | $0.01 – $0.34 | 40 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $747.95 | $1,150.70 | $0.01 – $0.01 | 40 |
| Gw stiffened micro access kit HCPCS C1894 | $9,830.88 | $15,124.43 | $0.01 – $0.88 | 40 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $124.20 | $124.20 | $46.95 – $139.80 | 40 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $3.65 | $3.65 | $1.38 – $4.11 | 40 |
| Handpiece aquabeam hp2000 HCPCS C2596 | $14,876.30 | $22,886.61 | $2,790.70 – $8,310.08 | 40 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $128.70 | $198.00 | $74.84 – $222.87 | 40 |
| Hand X-ray CPT 73130 | $305.50 | $470.00 | $118.31 – $352.31 | 40 |
| Hand X-ray (2 views, both hands) CPT 73120 | $235.95 | $363.00 | $91.48 – $272.40 | 40 |
| Haptoglobin quantitative CPT 83010 | $126.10 | $194.00 | $73.33 – $218.37 | 40 |
| Hcg qualitative CPT 84703 | $85.15 | $131.00 | $49.52 – $147.45 | 40 |
| Hcg quantitative CPT 84702 | $109.20 | $168.00 | $15.05 – $189.10 | 40 |
| Head CT scan (without contrast) CPT 70450 | $1,368.25 | $2,105.00 | $795.69 – $2,369.39 | 40 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $274.95 | $423.00 | $106.60 – $317.42 | 40 |
| Helicobacter pylori antibody igm CPT 86677 | $79.95 | $123.00 | $46.49 – $138.45 | 40 |
| Hematocrit CPT 85014 | $30.55 | $47.00 | $2.35 – $52.90 | 40 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $34,281.50 | $34,281.50 | $11,959.50 – $38,587.26 | 111 |
| Hemoglobin CPT 85018 | $538.85 | $39.00 | $9.09 – $43.90 | 40 |
| Hemoglobin fetal qualitative CPT 83033 | $128.70 | $198.00 | $74.84 – $222.87 | 40 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $74.75 | $115.00 | $43.47 – $129.44 | 26 |
| Hemoglobin plasma CPT 83051 | $83.85 | $129.00 | $7.16 – $129.00 | 40 |
| Heparin assay CPT 85520 | $53.95 | $83.00 | $31.37 – $93.42 | 40 |
| Heparin bolus from bag HCPCS J1644 | $80.00 | $80.00 | $2.20 – $7.77 | 110 |
| Heparin neutralization CPT 85525 | $47.45 | $73.00 | $27.59 – $82.17 | 40 |
| Hepatitis a antibody igm CPT 86709 | $100.10 | $154.00 | $58.21 – $173.34 | 40 |
| Hepatitis b core antibody igm CPT 86705 | $118.95 | $183.00 | $69.17 – $205.98 | 40 |
| Hepatitis b core antibody total CPT 86704 | $96.20 | $148.00 | $55.94 – $166.59 | 40 |
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | $3,148.75 | $3,148.75 | $130.66 – $436.45 | 111 |
| Hepatitis b surface antibody CPT 86706 | $107.90 | $166.00 | $62.75 – $186.85 | 40 |
| Hepatitis c antibody CPT 86803 | $126.75 | $195.00 | $13.98 – $195.00 | 40 |
| Herpes simplex type 1 antibody igg CPT 86695 | $85.80 | $132.00 | $49.90 – $148.58 | 26 |
| Herpes simplex type 2 antibody igg CPT 86696 | $57.85 | $89.00 | $33.64 – $100.18 | 26 |
| Heterophile antibodies screening CPT 86308 | $52.00 | $80.00 | $30.24 – $90.05 | 40 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $312.65 | $481.00 | $181.82 – $541.41 | 40 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $306.80 | $472.00 | $178.42 – $531.28 | 40 |
| Hip X-ray CPT 73502 | $222.30 | $342.00 | $129.28 – $384.96 | 40 |
| Hldr trach tb tie ad HCPCS A7526 | $1,057.54 | $1,626.99 | $0.22 – $0.66 | 40 |
| Holder tube cath-secure nonstrl lf disp HCPCS A4333 | $0.78 | $1.20 | $0.45 – $1.35 | 40 |
| Homocysteine CPT 83090 | $181.35 | $279.00 | $105.46 – $314.04 | 40 |
| Hopd mntl hlt, 15-29 min HCPCS C7900 | $396.50 | $610.00 | $230.58 – $686.62 | 40 |
| Hopd mntl hlt, grp HCPCS C7903 | $477.75 | $735.00 | $277.83 – $827.32 | 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.