Digestive disorders treatment (inpatient stay)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $8,136
- Cash Discount Price: $10,482
- vs. Medicare Baseline: 1.43x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $3,373 - $8,198 | 59% |
| Medicaid / KanCare | $3,373 - $8,294 | 59% |
| Humana | $3,373 - $8,136 | 59% |
| Blue Cross Blue Shield | $3,835 - $8,868 | 68% |
| Tricare | $5,878 | 104% |
| Providrs Care Network Contracted [320484] | $6,081 | 107% |
| Medica Contracted [320239] | $6,539 | 115% |
| Cigna | $7,986 - $9,286 | 141% |
| Cross Timbers Hospice [20098] | $8,136 | 143% |
| Pace Of The Ozarks Contracted [320518] | $8,136 | 143% |
| Halo Hcr Inc Hospice [20432] | $8,136 | 143% |
| Indian Health Service Contracted [320198] | $8,136 | 143% |
| Kindful Hospice [20434] | $8,136 | 143% |
| Elara Caring Aspire Hospice [20433] | $8,136 | 143% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $8,136 | 143% |
| Dept Of Veteran Affairs Contracted [320106] | $8,136 | 143% |
| Kindful Hospice Contracted [320434] | $8,136 | 143% |
| Mercy Hospice Okc [20252] | $8,136 | 143% |
| Halo Hcr Inc Hospice Contracted [320432] | $8,136 | 143% |
| Medicare (plans) | $8,136 - $8,185 | 143% |
| UnitedHealthcare | $8,294 | 146% |
| Home State Health Plan Contracted [320187] | $8,294 | 146% |
| Ambetter / Centene | $8,294 | 146% |
| Health Choice Contracted [320166] | $10,080 | 178% |
Consumer Guidance & Cost Commentary
For the CPT code 392, representing inpatient treatment for digestive disorders, Mercy Hospital Pittsburg, Inc. lists a gross charge of $16,126. While the facility's cash median price is $10,482, commercial insurance negotiated rates typically range from $3,373 to $10,080 depending on the payer. Notably, several major payers including Medicaid/KanCare, Humana, and Blue Cross Blue Shield have negotiated rates starting at $3,373, which is significantly lower than the cash price. However, patients should be aware that these negotiated rates often include administrative overhead and may exceed the cash price if the patient has a high deductible that has not yet been met. In such cases, paying the cash rate of $10,482 directly could result in lower out-of-pocket costs compared to the insurance allowed amount, provided the patient can afford the upfront payment and secures a prompt-pay discount.
The facility's Medicare benchmarking ratio is 1.4, indicating that the commercial negotiated rates are 40% higher than the Medicare amount of $5,675.87 for this procedure. This markup reflects the administrative costs and contract dynamics inherent in commercial insurance billing, which often inflate prices by 20% to 40% above the true cost of care. To ensure you are receiving the best possible rate, it is crucial to verify your specific plan's negotiated amount before scheduling, as in-network rates vary widely across different carriers. Additionally, since this is an acute care hospital in Pittsburg, KS, you should explicitly ask the billing department about self-pay or prompt-pay discounts, which can