CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Adventist Health Twin Cities

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $19,714
Cash Discount Price: $6,741
vs. Medicare Baseline: 3.47x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Adventist Health Twin Cities is $19,714. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,741. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 3.47x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$6,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,714

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: $6,741 (119%)

Insurance Median: $19,714 (347%)

Cash: $6,741 (119% of Medicare)

Ins. Median: $19,714 (347% 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 347% of the Medicare baseline (a markup of 247%). 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
Aetna	$7,464 - $26,758	132%
Cencal Mcr Adv - All Other Plans	$7,464	132%
Tricare	$7,464	132%
UnitedHealthcare	$7,464 - $43,519	132%
Coalinga-All Plans	$9,703	171%
Hpn-Heritage Prov Ntwrk-All Plans	$10,750	189%
Medi-Cal	$12,027	212%
Ccah-Centrl Ca Allince Mcal-All Plans	$12,490	220%
Ah Employee Health Plan - All Plans	$13,434	237%
Cencal Mcal	$13,711	242%
Blue Shield Promise Mcal	$14,457	255%
Nbd-Ntwrks By Design Exlus-All Other Plans	$24,971	440%
Blue Shield Epn	$26,670	470%
Nbd-Ntwrks By Design Non-Exlus	$30,230	533%
Blue Shield Hmo/Pos	$30,468	537%
Blue Shield Epo/Ppo - All Other Plans	$35,844	632%
Chn-Community Hlth Ntwrk-All Plans	$77,035	1357%
Pacific Health Alliance-All Plans	$86,665	1527%

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 $6,741.
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 Twin Cities 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.