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 |
|---|---|---|---|---|
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | $21.95 | $21.95 | $7.43 – $24.71 | 111 |
| Inj levocarnitine per 1 gm HCPCS J1955 | $178.80 | $178.80 | $67.59 – $201.26 | 40 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $64.80 | $64.80 | $24.49 – $72.94 | 40 |
| Inj. mycophenolate mofetil HCPCS J7519 | $108.10 | $108.10 | $20.50 – $121.68 | 111 |
| Inj, nithiodote, 3mg / 125mg HCPCS J0211 | $984.90 | $984.90 | $157.00 – $1,108.60 | 111 |
| Inj pantoprazole(hikma) 40mg HCPCS J2471 | $16.80 | $16.80 | $6.35 – $18.91 | 111 |
| Inj progesterone per 50 mg HCPCS J2675 | $3.00 | $3.00 | $0.63 – $3.38 | 111 |
| Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln HCPCS J9229 | $73,182.85 | $73,182.85 | $26,573.31 – $82,374.62 | 111 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $158.60 | $244.00 | $92.23 – $274.65 | 40 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $280.15 | $431.00 | $156.19 – $485.13 | 40 |
| Insole orthotic freedom sz6 6816 HCPCS L3060 | $44.30 | $68.15 | $25.76 – $76.71 | 40 |
| Insulin total CPT 83525 | $85.80 | $132.00 | $49.90 – $148.58 | 40 |
| Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm HCPCS Q4114 | $2,333.79 | $3,590.44 | $1,357.19 – $4,041.40 | 40 |
| Integra os putty 2.5cc - cost per 0.5cc HCPCS C9359 | $146.76 | $225.79 | $85.35 – $254.15 | 40 |
| Interferon beta-1a 30 mcg/0.5 ml im injection (wrapper) HCPCS Q3027 | $10,427.90 | $10,427.90 | $2,159.40 – $11,737.64 | 111 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $192.00 | $192.00 | $72.58 – $216.12 | 40 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $227.50 | $227.50 | $4.44 – $13.23 | 40 |
| Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 | $110,829.85 | $110,829.85 | $10,036.00 – $31,187.56 | 111 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $522.90 | $522.90 | $24.17 – $71.98 | 40 |
| Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 | $9,268.95 | $9,268.95 | $3,070.63 – $10,433.13 | 111 |
| Iron CPT 83540 | $53.30 | $82.00 | $31.00 – $92.30 | 40 |
| Iron binding capacity CPT 83550 | $63.05 | $97.00 | $36.67 – $109.18 | 40 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $185.90 | $185.90 | $70.27 – $209.25 | 40 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $174.00 | $174.00 | $22.00 – $195.85 | 111 |
| Irradiation of blood product each unit reference CPT 86945 | $202.15 | $311.00 | $117.56 – $350.06 | 40 |
| Isatuximab-irfc 20 mg/ml intravenous solution HCPCS J9227 | $2,779.35 | $2,779.35 | $906.80 – $3,128.44 | 111 |
| IV Fluids (each additional hour) CPT 96361 | $20,420.72 | $152.00 | $57.46 – $1,557.00 | 111 |
| IV Fluids (first hour) CPT 96360 | $239.85 | $369.00 | $139.48 – $415.35 | 40 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $113.10 | $174.00 | $65.77 – $195.85 | 40 |
| IV Medicine Infusion (additional drug) CPT 96367 | $10,741.15 | $294.00 | $20.80 – $330.93 | 111 |
| IV Medicine Infusion (each additional hour) CPT 96366 | $96.85 | $149.00 | $56.32 – $167.71 | 40 |
| IV Medicine Infusion (first hour) CPT 96365 | $14,463.15 | $445.00 | $168.21 – $5,763.60 | 111 |
| IV Push Injection (each additional drug) CPT 96375 | $27,759.06 | $192.00 | $72.58 – $6,300.00 | 111 |
| IV Push Injection (first drug) CPT 96374 | $5,813.86 | $310.00 | $3.84 – $348.94 | 111 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | $18,131.05 | $18,131.05 | $2,276.25 – $6,802.79 | 111 |
| Jkt lso inter HCPCS L0560 | $41.27 | $63.49 | $24.00 – $71.46 | 40 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $72.80 | $112.00 | $42.34 – $126.07 | 40 |
| Ketorolac (Toradol) Pain Shot, 15 mg HCPCS J1885 | $30.05 | $30.05 | $0.87 – $2.59 | 40 |
| Kit case 4.2mm spinejack HCPCS C1062 | $5,937.40 | $9,134.46 | $1,108.36 – $3,300.46 | 40 |
| Kit cast tcc 3in w/2reg boots total contact cast HCPCS Q4038 | $257.21 | $395.71 | $128.79 – $383.50 | 40 |
| Kit cath f 8f w/glv + wipe ster HCPCS A4353 | $1.31 | $2.02 | $0.50 – $1.50 | 40 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $6,430.77 | $9,893.50 | $2,188.15 – $6,515.82 | 40 |
| Kit hfx iq ipg bundle HCPCS C1822 | $26,541.53 | $40,833.13 | $14,870.26 – $44,280.34 | 40 |
| Kit ipg optimizer smart HCPCS C1824 | $29,051.10 | $44,694.00 | $16,894.33 – $44,502.85 | 40 |
| Kit irrigator stoma cone 7721 HCPCS A4398 | $2.05 | $3.16 | $1.19 – $3.56 | 40 |
| Kit lead specify 5-6-5 HCPCS C1778 | $13,454.45 | $20,699.16 | $54.18 – $161.33 | 40 |
| Kit monitr cath camino icp w/integratd licox bolt fitting HCPCS A9279 | $1,313.77 | $2,021.18 | $764.01 – $2,275.04 | 40 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $1,391.79 | $2,141.22 | $776.96 – $2,313.63 | 40 |
| Kit omnigraft 2.5x2.5cm dermal regeneration matrix - q4105-cost per sq cm HCPCS Q4105 | $234.08 | $360.12 | $79.69 – $237.31 | 40 |
| Kit sound processor cochlear osia 2 HCPCS L8691 | $6,106.28 | $9,394.28 | $2,406.17 – $7,165.03 | 40 |
| Kit trach suct cls 30.5cm HCPCS A4605 | $3,140.14 | $4,830.98 | $15.82 – $47.11 | 40 |
| Knee X-ray CPT 73564 | $483.60 | $744.00 | $187.49 – $558.30 | 40 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $266.50 | $410.00 | $103.19 – $307.29 | 40 |
| Knee X-ray (3 views, both knees) CPT 73562 | $319.15 | $491.00 | $123.61 – $368.07 | 40 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $356.60 | $356.60 | $134.79 – $401.39 | 40 |
| Lactate dehydrogenase (ldh) CPT 83615 | $48.75 | $75.00 | $28.35 – $84.42 | 40 |
| Lactated ringers intravenous solution HCPCS J7120 | $20.00 | $20.00 | $7.56 – $22.51 | 40 |
| Lactic acid CPT 83605 | $81.90 | $126.00 | $47.63 – $141.83 | 40 |
| Lactoferrin fecal qualitative CPT 83630 | $126.75 | $195.00 | $19.31 – $195.00 | 40 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | $29,832.00 | $29,832.00 | $11,276.50 – $33,578.90 | 40 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $2,873.32 | $4,420.50 | $56.02 – $113.76 | 40 |
| Lead capillary CPT 83655 | $90.35 | $139.00 | $52.54 – $156.46 | 40 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $4,159.75 | $6,399.62 | $0.14 – $0.29 | 40 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $8,202.66 | $12,619.48 | $51.78 – $105.15 | 40 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $2,269.15 | $3,491.00 | $879.61 – $2,619.27 | 40 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $2,120.95 | $3,263.00 | $822.15 – $2,448.18 | 40 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $419.25 | $645.00 | $18.90 – $56.28 | 40 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $5,701.93 | $1,065.00 | $0.32 – $56.28 | 111 |
| Lens iol ant chamb 10.5 HCPCS V2630 | $354.25 | $545.00 | $18.90 – $56.28 | 40 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $396.40 | $396.40 | $3.95 – $15.48 | 111 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $37,312.35 | $37,312.35 | $132.55 – $394.69 | 111 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $8.10 | $8.10 | $2.25 – $8.95 | 111 |
| Levetiracetam therapeutic drug level CPT 80177 | $130.00 | $200.00 | $75.60 – $225.12 | 40 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $61.50 | $61.50 | $1.96 – $7.32 | 111 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $553.55 | $553.55 | $77.00 – $623.08 | 111 |
| Liberta rc ipg HCPCS C1820 | $29,884.39 | $45,975.98 | $25.97 – $77.34 | 40 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $37.50 | $37.50 | $14.18 – $42.21 | 40 |
| Lidocaine therapeutic drug level CPT 80176 | $43.55 | $67.00 | $25.33 – $75.42 | 40 |
| Lift heel adj small gl60404sm HCPCS L3332 | $38.34 | $58.98 | $22.29 – $66.39 | 40 |
| Lift heel adjustable med HCPCS L3334 | $3.03 | $4.66 | $1.76 – $5.25 | 40 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $64.50 | $64.50 | $10.41 – $72.60 | 111 |
| Lipase CPT 83690 | $83.20 | $128.00 | $48.38 – $144.08 | 40 |
| Lipoprotein direct measurement hdl CPT 83718 | $62.40 | $96.00 | $8.03 – $96.00 | 40 |
| Lipoprotein direct measurement ldl CPT 83721 | $62.40 | $96.00 | $36.29 – $108.06 | 40 |
| Lithium therapeutic drug level CPT 80178 | $61.10 | $94.00 | $6.74 – $105.81 | 40 |
| Liver Function Test CPT 80076 | $110.50 | $170.00 | $64.26 – $191.35 | 40 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | $87,089.35 | $87,089.35 | $31,546.27 – $98,027.77 | 111 |
| Loop ostmy bridg ster HCPCS A4421 | $45.43 | $69.90 | $0.14 – $0.36 | 32 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $22.20 | $22.20 | $2.00 – $5.97 | 40 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,517.10 | $2,334.00 | $882.25 – $2,627.15 | 40 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $286.00 | $440.00 | $166.32 – $495.26 | 40 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $369.20 | $568.00 | $214.70 – $639.34 | 40 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $295.75 | $455.00 | $114.53 – $341.06 | 40 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $25,230.00 | $25,230.00 | $9,022.80 – $28,398.89 | 111 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $37,758.50 | $37,758.50 | $4,196.00 – $14,167.03 | 111 |
| Lvad shower bag heartmate HCPCS Q0501 | $887.68 | $1,365.66 | $516.22 – $1,537.19 | 40 |
| Macroscopic exam arthropod CPT 87168 | $40.95 | $63.00 | $4.18 – $63.00 | 40 |
| Macroscopic exam parasite CPT 87169 | $19.50 | $30.00 | $4.22 – $30.00 | 40 |
| Magnesium CPT 83735 | $69.55 | $107.00 | $40.45 – $120.44 | 40 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $522.50 | $522.50 | $0.50 – $13.39 | 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.