MercyOne West Des Moines Medical Center
1755 59th Place, West Des Moines, IA · MercyOne · · NPI 1538395975
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 |
|---|---|---|---|---|
| 3d ech img cgen car anomal CPT 93319 | $2,041.00 | $2,041.00 | $13.21 – $2,041.00 | 779 |
| 3d recon without postprocess indpndt CPT 76376 | $666.00 | $666.00 | $133.87 – $666.00 | 26 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $182.00 | $182.00 | $19.65 – $182.00 | 28 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $7,377.95 | $7,377.95 | $43.87 – $7,377.95 | 110 |
| Abd/low ext cath 1st CPT 36245 | $5,338.00 | $5,338.00 | $715.16 – $3,558.00 | 26 |
| Abd/low ext cath 2nd CPT 36246 | $4,498.00 | $4,498.00 | $602.80 – $2,999.00 | 26 |
| Abd/low ext cath 3rd CPT 36247 | $7,755.00 | $7,755.00 | $1,039.17 – $5,170.00 | 26 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $1,829.00 | $1,829.00 | $33.87 – $1,829.00 | 780 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $1,536.00 | $1,536.00 | $98.68 – $1,536.00 | 110 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $4,983.00 | $4,983.00 | $165.56 – $4,983.00 | 110 |
| Abdominal CT scan (with contrast) CPT 74160 | $4,615.00 | $4,615.00 | $165.56 – $4,615.00 | 110 |
| Abdominal CT scan (without contrast) CPT 74150 | $3,184.00 | $3,184.00 | $98.68 – $3,184.00 | 110 |
| Abdominal MRI (with and without contrast) CPT 74183 | $7,916.00 | $7,916.00 | $329.29 – $7,916.00 | 110 |
| Abdominal MRI (without contrast) CPT 74181 | $5,382.00 | $5,382.00 | $225.21 – $5,382.00 | 110 |
| Abdominal paracentesis w/image guidance CPT 49083 | $10,246.00 | $10,246.00 | $29.61 – $10,246.00 | 780 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,826.00 | $1,826.00 | $98.68 – $1,826.00 | 110 |
| Abdominal Ultrasound (limited) CPT 76705 | $1,259.00 | $1,259.00 | $98.68 – $1,259.00 | 110 |
| Abdominal X-ray (2 views) CPT 74019 | $579.00 | $579.00 | $98.68 – $579.00 | 110 |
| Abdominal X-ray (single view) CPT 74018 | $19,312.13 | $463.00 | $0.96 – $463.00 | 110 |
| Abdominoplasty 15830 CPT 15830 | $35,112.27 | not published | $1.92 – $12,891.30 | 83 |
| Ablate heart dysrhythm focus CPT 93650 | $22,504.00 | $22,504.00 | $4,523.30 – $22,504.00 | 108 |
| Ablation cardiac vagal inputs atrium CPT 93799 | $3,621.00 | $3,621.00 | $121.46 – $3,621.00 | 108 |
| Abscess drain retroperitoneal surg code CPT 49406 | $670.00 | $670.00 | $134.67 – $3,206.43 | 108 |
| Acetaminophen 120 mg rectal suppository HCPCS A9270 | $29,976.80 | $2,532.65 | $0.20 – $14,087.30 | 110 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $184.00 | $184.00 | $17.23 – $184.00 | 94 |
| Acetylcholine receptor modulating antibody CPT 86043 | $70.00 | $70.00 | $11.68 – $70.00 | 44 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $172.50 | $172.50 | $22.20 – $172.50 | 94 |
| Acute hepatitis panel CPT 80074 | $927.00 | $927.00 | $46.16 – $927.00 | 44 |
| Acyclovir 400 mg tablet HCPCS J8499 | $1.00 | $1.00 | $0.16 – $1.00 | 32 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $20.70 | $20.70 | $0.84 – $4.20 | 94 |
| Adapter b 8 channel 10cm HCPCS C1883 | $30,555.23 | $30,555.23 | $0.01 – $13.86 | 28 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $695.70 | $695.70 | $1.51 – $7.50 | 28 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $61.10 | $61.10 | $0.20 – $1.00 | 94 |
| Administration immunization each additional component CPT 90461 | $32.00 | $32.00 | $3.96 – $81.00 | 44 |
| Administration immunization each additional vaccine CPT 90472 | $70.00 | $70.00 | $3.96 – $81.00 | 28 |
| Administration immunization first component each vaccine CPT 90460 | $66.00 | $66.00 | $3.96 – $81.00 | 44 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $61.00 | $61.00 | $3.96 – $139.78 | 110 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $36.00 | $36.00 | $3.96 – $81.00 | 28 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $60.00 | $60.00 | $3.96 – $81.00 | 44 |
| Administration vaccine hepatitis b HCPCS G0010 | $88.00 | $88.00 | $3.96 – $90.91 | 107 |
| Administration vaccine influenza virus HCPCS G0008 | $177.00 | $177.00 | $3.96 – $90.91 | 110 |
| Administration vaccine pneumococcal HCPCS G0009 | $88.00 | $88.00 | $3.96 – $90.91 | 110 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $56.00 | $56.00 | $3.96 – $81.00 | 44 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $19,916.25 | $19,916.25 | $38.66 – $12,447.70 | 110 |
| Advance care planning each additional 30 min 99498 CPT 99498 | $178.00 | $178.00 | $33.84 – $151.00 | 768 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $18,756.30 | $18,756.30 | $213.59 – $18,756.30 | 110 |
| Albumin body fluid quantitative each specimen CPT 82042 | $219.00 | $219.00 | $7.54 – $119.00 | 44 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | $871.00 | $871.00 | $87.54 – $435.50 | 28 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | $332.50 | $332.50 | $43.72 – $217.50 | 28 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $96.00 | $96.00 | $5.60 – $96.00 | 44 |
| Albumin serum plasma or whole blood CPT 82040 | $40,341.40 | $130.00 | $4.79 – $13,116.76 | 110 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $146.00 | $146.00 | $16.74 – $146.00 | 44 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $89,232.75 | $89,232.75 | $2,398.16 – $89,232.75 | 110 |
| Alkaline phosphatase CPT 84075 | $188.00 | $188.00 | $5.02 – $76.00 | 44 |
| Allergen alpha lactalbumin ige CPT 86008 | $48.00 | $48.00 | $9.65 – $48.00 | 44 |
| Allergen egg white ige CPT 86003 | $83.00 | $83.00 | $3.22 – $16.00 | 44 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $66.55 | $66.55 | $10.86 – $66.55 | 36 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $653.33 | $653.33 | $37.83 – $231.82 | 36 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $6,093.98 | $6,093.98 | $18.57 – $113.80 | 36 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $5,636.14 | $5,636.14 | $6.05 – $37.10 | 36 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $245.37 | $245.37 | $4.71 – $28.85 | 36 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $3,227.12 | $3,227.12 | $10.27 – $62.95 | 36 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $366.35 | $366.35 | $32.64 – $200.01 | 36 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $8,630.50 | $8,630.50 | $126.11 – $772.75 | 36 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $358.06 | $358.06 | $56.37 – $345.41 | 36 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $1,254.67 | $1,254.67 | $98.26 – $602.10 | 36 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $2,450.00 | $2,450.00 | $5.33 – $2,450.00 | 31 |
| Alpha-fetoprotein tumor marker CPT 82105 | $206.00 | $206.00 | $16.25 – $206.00 | 44 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $25,477.05 | $25,477.05 | $53.07 – $264.05 | 110 |
| Alt/sgpt CPT 84460 | $203.00 | $203.00 | $5.14 – $203.00 | 44 |
| Alys cplx sp/pn npgt w/prgrm CPT 95972 | $1,640.00 | $1,640.00 | $89.73 – $1,640.00 | 110 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $17.05 | $17.05 | $1.05 – $5.20 | 94 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $47.20 | $47.20 | $5.53 – $27.50 | 94 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $101.15 | $101.15 | $3.69 – $18.35 | 28 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $212.00 | $212.00 | $11.46 – $57.00 | 94 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $79.05 | $79.05 | $0.78 – $3.90 | 94 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | $11,933.95 | $11,933.95 | $19.77 – $11,933.95 | 110 |
| Ammonia CPT 82140 | $338.00 | $338.00 | $14.12 – $338.00 | 44 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $8.75 | $8.75 | $1.76 – $72.60 | 94 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $1,507.85 | $1,507.85 | $52.63 – $562.35 | 31 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $38.85 | $38.85 | $0.98 – $9.70 | 94 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $590.00 | $590.00 | $1.28 – $6.35 | 94 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $789.00 | $789.00 | $158.59 – $789.00 | 41 |
| Amp metatarsal w/toe single 28810 CPT 28810 | $1,460.00 | $1,460.00 | $126.52 – $1,159.77 | 768 |
| Amputation toe metatarsophalangeal joint CPT 28820 | $14,299.20 | not published | $9.09 – $6,352.30 | 83 |
| Amylase CPT 82150 | $120.00 | $120.00 | $6.28 – $120.00 | 44 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $628.00 | $628.00 | $110.88 – $628.00 | 39 |
| Analysis gene f2 20210g>a variant CPT 81240 | $272.00 | $272.00 | $54.67 – $272.00 | 44 |
| Analysis gene f5 leiden variant CPT 81241 | $365.00 | $365.00 | $71.09 – $365.00 | 44 |
| Analyze neurostimulator simple w/reprogramming 95971 CPT 95971 | $1,100.00 | $1,100.00 | $89.73 – $1,100.00 | 110 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $127.00 | $127.00 | $25.53 – $127.00 | 44 |
| An cholangiogram percutaneous compl CPT 47531 | $14,166.00 | $14,166.00 | $2,847.37 – $14,166.00 | 108 |
| Anchor suture 3.5mm pushlock HCPCS C1741 | $3,315.38 | $3,315.38 | $338.46 – $1,683.89 | 28 |
| An fluoro guide for cvp CPT 77001 | $1,162.00 | $1,162.00 | $1.81 – $1,162.00 | 779 |
| Angioplasty fem/pop unilat 37224 CPT 37224 | $21,426.00 | $21,426.00 | $2,331.15 – $14,284.00 | 34 |
| Angioplasty tib/pero/unilat/ea add 37232 CPT 37232 | $16,801.00 | $16,801.00 | $2,741.92 – $16,801.00 | 34 |
| Angio trnslmnl balloon same vein ini CPT 37248 | $18,486.00 | $18,486.00 | $2,477.12 – $12,324.00 | 108 |
| Ankle X-ray CPT 73610 | $972.00 | $972.00 | $82.14 – $648.00 | 110 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $796.00 | $796.00 | $82.14 – $530.00 | 110 |
| Ant colporrhaphy/rpr cyctocele 57240 CPT 57240 | $1,840.00 | $1,840.00 | $21.08 – $213.76 | 768 |
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.