CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Mercyone Dyersville Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 74177
  • Insurance Median: $4,662
  • Cash Discount Price: $3,664
  • vs. Medicare Baseline: 13.08x Medicare
The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Mercyone Dyersville Medical Center is $4,662. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,664. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 13.08x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.
Cash / Self-Pay
$3,664

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,662

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)
Cash / Self-Pay: $3,664 (1028%)
Insurance Median: $4,662 (1308%)
Cash: $3,664 (1028% of Medicare)
Ins. Median: $4,662 (1308% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 1308% of the Medicare baseline (a markup of 1208%). 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 $2,131 598%
Blue Cross Blue Shield $3,125 877%
Medicare (plans) $3,188 - $3,480 894%
UnitedHealthcare $3,346 - $3,946 939%
The Alliance $3,428 962%
Iowa Total Care $3,910 1097%
Geha $3,946 1107%
Medicaid / KanCare $3,967 - $3,986 1113%
Amish Hospital Aid $4,198 1178%
1199 National Benefit Fund $4,662 1308%
Aetna $4,662 1308%
Allied Benefit Systems $4,662 1308%
Asr Health Benefits $4,662 1308%
Christian Brother Services $4,662 1308%
Coventry $4,662 1308%
First Health $4,662 1308%
Luminare Health $4,662 1308%
Medical Mutual $4,662 1308%
Meritain $4,662 1308%
Trustmark Small Business Benefits $4,662 1308%
Webtpa $4,662 1308%
Auxiant $5,073 1423%
Cigna $5,073 1423%
Medica $5,073 1423%
Midlands $5,073 1423%
Midlands Choice $5,073 1423%
Multiplan $5,073 1423%
Ambetter / Centene $5,303 1488%
Crime Victim Assistance $5,637 1582%
Iowa Dept Of Public Health $5,637 1582%
Claimdoc $6,345 1780%
Nova $6,345 1780%

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