CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Adventist Health and Rideout

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $33,241
Cash Discount Price: $10,344
vs. Medicare Baseline: 5.86x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Adventist Health and Rideout is $33,241. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,344. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 5.86x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$10,344

Average discount available for prompt cash payment at this facility.

Insurance Median

$33,241

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: $10,344 (182%)

Insurance Median: $33,241 (586%)

Cash: $10,344 (182% of Medicare)

Ins. Median: $33,241 (586% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 586% of the Medicare baseline (a markup of 486%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Healthnet Mcal	$5,896	104%
Kaiser Mcr Adv	$7,490	132%
Tricare	$7,490	132%
UnitedHealthcare	$7,490 - $40,839	132%
Blue Cross Blue Shield	$7,565 - $34,746	133%
Kaiser Mcal	$12,210	215%
Medi-Cal	$12,210	215%
Ah Employee Health Plan - All Plans	$13,481	238%
Ca Health And Wellness- All Plans	$19,547	344%
Celtic Mcaid-All Plans	$19,547	344%
Bc Mcal	$24,457	431%
Partnership Hp Mcal -All Plans	$24,895	439%
Aetna	$33,241	586%
Kaiser-All Other Plans	$35,733	630%
Healthnet Comm-All Other Plans	$35,921	633%
Blue Shield Uc Care Members	$37,614	663%
Cigna	$40,468	713%
First Health-All Plans	$41,140	725%
Interplan-All Plans	$42,315	746%
Phcs-All Plans	$42,315	746%
Blue Shield-All Other Plans	$44,666	787%
Multiplan-All Plans	$44,666	787%

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 $10,344.
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 Adventist Health and Rideout 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.