CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Seneca District Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $1,831
Cash Discount Price: $1,542
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Seneca District Hospital is $1,831. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,542. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 0.32x the Medicare baseline. Located in 130 Brentwood Drive, Chester, CA.

Cash / Self-Pay

$1,542

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,831

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: $1,542 (27%)

Insurance Median: $1,831 (32%)

Cash: $1,542 (27% of Medicare)

Ins. Median: $1,831 (32% 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
Tricare	$1,445	25%
Medi-Cal	$1,657	29%
Blue Shield Ipf/Ca Exchange	$1,717	30%
Blue Cross Blue Shield	$1,735 - $1,754	31%
Beech Street Corp- All Plans	$1,831	32%
Cigna	$1,831	32%
Integrated Hp-All Plans	$1,831	32%
Interplan Corp- All Plans	$1,831	32%
Medincrease- All Plans	$1,831	32%
Multiplan- All Plans	$1,831	32%
Pacificare - All Plans	$1,831	32%
Provider Ntwrk Of America-All Plans	$1,831	32%
UnitedHealthcare	$1,831	32%
Alliance- All Plans	$1,869	33%
Community Care Network - All Plans	$1,869	33%
Coventry- All Plans	$1,889	33%
Northern Nevada Health Network- All Plans	$1,889	33%
Superior California Ppo - All Plans	$1,889	33%
Blue Shield Of Ca- All Other Plans	$1,908	34%
Healthnet - All Other Plans	$1,908	34%
Three Rivers- All Plans	$1,908	34%

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 $1,542.
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 Seneca District Hospital 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.