MercyOne Oelwein Medical Center
201 8th Ave SE, Oelwein, IA · MercyOne · · NPI 1528009511
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 |
|---|---|---|---|---|
| Tissue amnio epifix inj 100mg HCPCS Q4145 | $2,555.89 | $3,932.14 | $789.38 – $2,065.35 | 44 |
| Tissue dermagraft 2x3in 37.5sqcm-cost per sq cm HCPCS Q4431 | $67.73 | $104.20 | $39.83 – $104.20 | 44 |
| Tissue exam koh skin/hair/nails CPT 87220 | $28.60 | $44.00 | $16.82 – $44.00 | 44 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $271.69 | $417.99 | $159.76 – $417.99 | 44 |
| Tissue matrix xcm thk 20x30cm -cost per sq cm HCPCS Q4142 | $49.04 | $75.45 | $28.84 – $75.45 | 44 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | $38.88 | $59.82 | $22.86 – $59.82 | 44 |
| Tissue transglutaminase iga CPT 86364 | $176.80 | $272.00 | $103.96 – $272.00 | 44 |
| Tl-201 thallium diag per mci HCPCS A9505 | $80.10 | $80.10 | $30.61 – $80.10 | 44 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $3.65 | $3.65 | $1.38 – $3.60 | 115 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $12,214.20 | $12,214.20 | $463.20 – $2,442.90 | 115 |
| Toe X-ray (both feet) CPT 73660 | $270.40 | $416.00 | $105.87 – $277.00 | 44 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $221.65 | $341.00 | $86.76 – $227.00 | 43 |
| Tomosynthesis breast screen bilateral CPT 77063 | $78.00 | $120.00 | $30.58 – $80.00 | 44 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $188.75 | $188.75 | $43.95 – $115.00 | 44 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | $48,786.25 | $48,786.25 | $9,480.00 – $48,786.25 | 115 |
| Trabectedin 1 mg intravenous solution HCPCS J9352 | $11,842.80 | $11,842.80 | $4,192.10 – $11,842.80 | 115 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $157.30 | $242.00 | $92.49 – $242.00 | 44 |
| Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution HCPCS J3290 | $41.50 | $41.50 | $2.00 – $20.25 | 115 |
| Transferrin CPT 84466 | $109.85 | $169.00 | $64.59 – $169.00 | 44 |
| Transvaginal Pelvic Ultrasound (not pregnancy) CPT 76830 | $558.35 | $859.00 | $328.31 – $859.00 | 44 |
| Transvaginal Pregnancy Ultrasound CPT 76817 | $589.55 | $907.00 | $346.66 – $907.00 | 44 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | $4,708.00 | $4,708.00 | $1,250.55 – $4,675.30 | 115 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | $10,508.35 | $10,508.35 | $649.20 – $2,766.05 | 115 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | $9,357.40 | $9,357.40 | $429.30 – $3,365.30 | 115 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,798.25 | $4,305.00 | $1,316.30 – $3,444.00 | 44 |
| Tray bonemarrw oncontrol 102mm HCPCS C1830 | $699.55 | $1,076.23 | $23.31 – $61.00 | 44 |
| Tray trach basic clean/care ster HCPCS A4626 | $0.51 | $0.78 | $0.30 – $0.78 | 44 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $158.60 | $244.00 | $93.26 – $244.00 | 44 |
| Tremelimumab-actl 20 mg/ml intravenous solution HCPCS J9347 | $127,265.40 | $127,265.40 | $3,862.00 – $10,605.45 | 115 |
| Treponema pallidum antibody CPT 86780 | $130.00 | $200.00 | $76.44 – $200.00 | 44 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $39.10 | $39.10 | $14.94 – $39.10 | 44 |
| Triglycerides CPT 84478 | $50.05 | $77.00 | $5.63 – $77.00 | 44 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | $8,065.15 | $8,065.15 | $1,617.00 – $8,065.15 | 115 |
| Troponin quantitative CPT 84484 | $812.00 | $192.00 | $12.22 – $192.00 | 44 |
| Tube drain vert dev st 5-40f HCPCS A5200 | $17.68 | $27.20 | $10.40 – $27.20 | 44 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $416.99 | $641.52 | $1.30 – $3.39 | 44 |
| Tube trach disp innr can 6 xlt HCPCS A4623 | $2.78 | $4.27 | $0.75 – $1.97 | 44 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | $128.12 | $197.11 | $0.42 – $1.10 | 44 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | $35,496.45 | $35,496.45 | $10,785.00 – $35,496.45 | 115 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $729.30 | $1,122.00 | $75.49 – $748.00 | 44 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $534.95 | $823.00 | $314.55 – $823.00 | 44 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $446.55 | $687.00 | $262.57 – $687.00 | 44 |
| Unit mobile power mpu HCPCS Q0479 | $11,821.68 | $18,187.20 | $6,951.15 – $18,187.20 | 44 |
| Unlisted procedure microbiology CPT 87999 | $2,388.75 | $3,675.00 | $1,404.59 – $3,675.00 | 44 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $201.50 | $310.00 | $118.48 – $310.00 | 44 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,330.55 | $2,047.00 | $782.36 – $2,047.00 | 44 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $4,634.50 | $7,130.00 | $2,725.09 – $7,130.00 | 44 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,551.90 | $3,926.00 | $1,500.52 – $3,926.00 | 43 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $261.30 | $402.00 | $153.64 – $402.00 | 44 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $333.45 | $513.00 | $196.07 – $513.00 | 44 |
| Urea nitrogen CPT 84520 | $242.00 | $65.00 | $3.87 – $65.00 | 44 |
| Uric acid blood CPT 84550 | $57.85 | $89.00 | $34.02 – $89.00 | 44 |
| Uric acid urine CPT 84560 | $66.30 | $102.00 | $4.98 – $102.00 | 44 |
| Urinalysis (with microscopy) CPT 81001 | $392.00 | $68.00 | $3.11 – $68.00 | 44 |
| Urinalysis (without microscopy) CPT 81003 | $385.00 | $61.00 | $2.21 – $61.00 | 44 |
| Urine Culture Test CPT 87086 | $392.00 | $90.00 | $7.91 – $90.00 | 44 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $6,677.00 | $6,677.00 | $1,727.70 – $6,677.00 | 115 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $45,913.60 | $45,913.60 | $3,644.10 – $45,913.60 | 115 |
| Vaccine Administration (one shot) CPT 90471 | $95.55 | $147.00 | $7.52 – $19.68 | 44 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $273.00 | $420.00 | $160.52 – $420.00 | 115 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $533.00 | $820.00 | $147.06 – $820.00 | 115 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $98.15 | $151.00 | $57.71 – $168.37 | 115 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $65.65 | $101.00 | $38.60 – $101.00 | 115 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $49.40 | $76.00 | $29.05 – $76.00 | 115 |
| Vaccine dtap < 7 years im CPT 90700 | $33.15 | $51.00 | $19.49 – $51.00 | 115 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $95.55 | $147.00 | $56.18 – $147.00 | 115 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $54.60 | $84.00 | $32.10 – $84.00 | 115 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | $128.70 | $198.00 | $75.68 – $198.00 | 115 |
| Vaccine dtap-ipv/hib im CPT 90698 | $98.15 | $151.00 | $57.71 – $151.00 | 115 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $37.05 | $57.00 | $21.79 – $57.00 | 115 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $35.10 | $54.00 | $13.17 – $54.00 | 115 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $135.85 | $209.00 | $72.68 – $209.00 | 115 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $118.95 | $183.00 | $69.94 – $183.00 | 115 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $43.55 | $67.00 | $25.61 – $67.00 | 115 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | $45.50 | $70.00 | $26.75 – $70.00 | 44 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | $54.60 | $84.00 | $32.10 – $84.00 | 115 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $345.70 | $345.70 | $70.38 – $210.00 | 115 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $310.70 | $478.00 | $177.56 – $478.00 | 115 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $138.80 | $138.80 | $31.67 – $90.00 | 115 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $245.05 | $377.00 | $144.09 – $377.00 | 115 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $215.15 | $331.00 | $126.51 – $331.00 | 44 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $142.35 | $219.00 | $83.70 – $219.00 | 115 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $303.40 | $303.40 | $31.72 – $98.16 | 115 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $20.15 | $31.00 | $11.85 – $31.00 | 115 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $102.45 | $102.45 | $11.47 – $30.00 | 115 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $40.95 | $63.00 | $18.44 – $63.00 | 115 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | $150.15 | $231.00 | $67.98 – $231.00 | 115 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $19.50 | $30.00 | $11.47 – $30.00 | 115 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $43.55 | $67.00 | $19.73 – $67.00 | 115 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | $20.80 | $32.00 | $9.22 – $32.00 | 115 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | $53.95 | $83.00 | $24.50 – $83.00 | 115 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | $142.35 | $219.00 | $64.51 – $219.00 | 115 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $499.85 | $769.00 | $49.50 – $769.00 | 115 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | $31.20 | $48.00 | $11.03 – $48.00 | 115 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $180.70 | $278.00 | $106.25 – $278.00 | 115 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $161.20 | $248.00 | $94.79 – $248.00 | 115 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $142.35 | $219.00 | $83.70 – $219.00 | 115 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $382.20 | $588.00 | $166.75 – $588.00 | 115 |
| Vaccine mmr live subcutaneous CPT 90707 | $79.30 | $122.00 | $46.63 – $122.00 | 115 |
| Vaccine mmrv live subcutaneous CPT 90710 | $403.65 | $621.00 | $237.35 – $621.00 | 115 |
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.