CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Mercyone Dyersville Medical Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74176
  • Insurance Median: $3,884
  • Cash Discount Price: $3,052
  • vs. Medicare Baseline: 15.93x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Mercyone Dyersville Medical Center is $3,884. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,052. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 15.93x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.
Cash / Self-Pay
$3,052

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,884

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $3,052 (1252%)
Insurance Median: $3,884 (1593%)
Cash: $3,052 (1252% of Medicare)
Ins. Median: $3,884 (1593% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1593% of the Medicare baseline (a markup of 1493%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Health Choices $1,775 728%
Blue Cross Blue Shield $2,603 1068%
Medicare (plans) $2,656 - $2,899 1090%
UnitedHealthcare $2,788 - $3,287 1144%
The Alliance $2,856 1172%
Iowa Total Care $3,257 1336%
Geha $3,287 1348%
Medicaid / KanCare $3,305 - $3,321 1356%
Amish Hospital Aid $3,498 1435%
1199 National Benefit Fund $3,884 1593%
Aetna $3,884 1593%
Allied Benefit Systems $3,884 1593%
Asr Health Benefits $3,884 1593%
Christian Brother Services $3,884 1593%
Coventry $3,884 1593%
First Health $3,884 1593%
Luminare Health $3,884 1593%
Medical Mutual $3,884 1593%
Meritain $3,884 1593%
Trustmark Small Business Benefits $3,884 1593%
Webtpa $3,884 1593%
Auxiant $4,226 1734%
Cigna $4,226 1734%
Medica $4,226 1734%
Midlands $4,226 1734%
Midlands Choice $4,226 1734%
Multiplan $4,226 1734%
Ambetter / Centene $4,418 1812%
Crime Victim Assistance $4,696 1926%
Iowa Dept Of Public Health $4,696 1926%
Claimdoc $5,286 2168%
Nova $5,286 2168%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1111 3Rd Street Sw, Dyersville, IA 52040
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals