CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Mercyone North Iowa Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $6,052
Cash Discount Price: $31,290
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Mercyone North Iowa Medical Center is $6,052. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,290. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.07x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$31,290

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,052

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $31,290 (551%)

Insurance Median: $6,052 (107%)

Cash: $31,290 (551% of Medicare)

Ins. Median: $6,052 (107% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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.

Out-of-Pocket Cost Estimator

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

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Iowa Total Care	$5,213	92%
Medicaid / KanCare	$5,264 - $5,284	93%
Aetna	$5,844	103%
Medicare (plans)	$5,844 - $6,082	103%
Blue Cross Blue Shield	$5,902	104%
UnitedHealthcare	$5,961 - $13,678	105%
Preferred One	$7,161	126%
Centivo	$7,334	129%
Oscar	$7,684	135%
Amish Hospital Aid	$7,931	140%
Ambetter / Centene	$10,018	177%
Claimdoc	$11,985	211%
Nova	$11,985	211%
Geha	$13,678	241%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $31,290.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercyone North Iowa Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.