CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mercyone North Iowa Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $63
Cash Discount Price: $1,427
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercyone North Iowa Medical Center is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,427. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.92x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$1,427

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $1,427 (4360%)

Insurance Median: $63 (192%)

Cash: $1,427 (4360% of Medicare)

Ins. Median: $63 (192% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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	$26	79%
Medicaid / KanCare	$27	82%
Aetna	$31 - $64	95%
Blue Cross Blue Shield	$31	95%
Health Choices	$31	95%
Medical Associates	$31	95%
Medicare (plans)	$31 - $32	95%
UnitedHealthcare	$31 - $350	95%
Centivo	$39	119%
Oscar	$41	125%
Amish Hospital Aid	$42	128%
Ambetter / Centene	$53	162%
Claimdoc	$63	192%
Nova	$63	192%
1199 National Benefit Fund	$64	196%
Allied Benefit Systems	$64	196%
Asr Health Benefits	$64	196%
Christian Brother Services	$64	196%
Coventry	$64	196%
First Health	$64	196%
Lucent Health	$64	196%
Luminare Health	$64	196%
Medical Mutual	$64	196%
Meritain	$64	196%
Trustmark Small Business Benefits	$64	196%
Webtpa	$64	196%
Preferred One	$79	241%
Health Partners	$82	251%
Auxiant	$85	260%
Cigna	$85	260%
Medica	$85	260%
Midlands	$85	260%
Midlands Choice	$85	260%
Mhnet	$98	299%
Multiplan	$110	336%
Crime Victim Assistance	$122	373%
Iowa Dept Of Public Health	$122	373%
Geha	$350	1069%

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 $1,427.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 CPT code 97112.
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.