CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Mercyone North Iowa Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $26,663
Cash Discount Price: $88,533
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Mercyone North Iowa Medical Center is $26,663. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88,533. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.13x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$88,533

Average discount available for prompt cash payment at this facility.

Insurance Median

$26,663

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $88,533 (377%)

Insurance Median: $26,663 (113%)

Cash: $88,533 (377% of Medicare)

Ins. Median: $26,663 (113% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 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
Aetna	$23,385	99%
Medicare (plans)	$23,385 - $24,340	99%
Blue Cross Blue Shield	$23,619	100%
UnitedHealthcare	$23,853 - $56,677	101%
Iowa Total Care	$26,353	112%
Medicaid / KanCare	$26,611 - $26,715	113%
Centivo	$29,351	125%
Preferred One	$29,671	126%
Oscar	$30,751	131%
Amish Hospital Aid	$31,737	135%
Ambetter / Centene	$40,089	171%
Claimdoc	$47,963	204%
Nova	$47,963	204%
Geha	$56,677	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 $88,533.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

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 451.
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.