CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Pinckneyville Community Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $8,499
Cash Discount Price: $18,860
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Pinckneyville Community Hospital is $8,499. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,860. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.50x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$18,860

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,499

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: $18,860 (332%)

Insurance Median: $8,499 (150%)

Cash: $18,860 (332% of Medicare)

Ins. Median: $8,499 (150% 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
Healthlink Hmo	$1,700	30%
Healthlink Ppo - All Other Plans	$1,870	33%
Healthlink Work Comp	$1,870	33%
Cigna	$2,438	43%
UnitedHealthcare	$4,500 - $9,526	79%
Blue Cross Blue Shield	$5,453	96%
Humana	$8,499	150%
Umwa Mcr Adv - All Plans	$8,499	150%
Wellcare Mcr Adv - All Plans	$8,499	150%
Aetna	$8,669 - $16,974	153%
Phcs - All Other Plans	$15,465	272%
Phcs Savility	$16,031	282%
Multiplan - All Plans	$16,974	299%

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 $18,860.
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 Pinckneyville Community 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.