Digestive disorders treatment (inpatient stay)
Facility: Stormont Vail Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $6,165
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.09x 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 |
|---|---|---|
| Ambetter / Centene | $3,896 - $7,680 | 69% |
| UnitedHealthcare | $3,896 - $7,680 | 69% |
| Blue Cross Blue Shield | $3,934 - $17,583 | 69% |
| Aetna | $5,103 - $6,165 | 90% |
| Humana | $5,103 - $6,165 | 90% |
Consumer Guidance & Cost Commentary
For the procedure code 392, "Digestive disorders treatment (inpatient stay)," at Stormont Vail Hospital in Topeka, KS, the commercial negotiated rates range from $3,896 to $17,583 depending on the insurance carrier. While the facility's median negotiated rate of $6,165 is higher than the state average, it remains significantly lower than the hospital's full chargemaster list price. Under Medicare benchmarking principles, this facility's rate represents approximately 109% of the Medicare amount of $5,675.87, which aligns closely with the fair pricing range of 120% to 150% of Medicare. This suggests the facility is pricing competitively relative to the federal cost baseline, avoiding the excessive markups often found in commercial billing.
Patients should be aware that cash-pay options may offer financial advantages if your insurance plan has a high deductible or if the negotiated rate exceeds the cash price. Although the cash median is not listed for this specific code, the facility offers a prompt-pay discount for upfront payments, which can bypass administrative fees and reduce the total cost by 20% to 50%. To secure the best possible rate, it is recommended to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts before scheduling, as these rates are often lower than the standard in-network negotiated amounts. Additionally, since this is an in-network facility, the No Surprises Act protects you from balance billing for out-of-network services rendered at the hospital, ensuring you only pay the negotiated amount rather than the difference between the chargemaster and your insurance allowed amount.