Digestive disorders treatment (inpatient stay)
Facility: Nemaha Valley Community Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $10,586
- Cash Discount Price: $12,073
- vs. Medicare Baseline: 1.87x 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 |
|---|---|---|
| Blue Cross Blue Shield | $7,365 | 130% |
| Va Ccn - All Plans | $9,156 | 161% |
| Humana | $9,156 | 161% |
| Aetna | $9,248 - $11,403 | 163% |
| Celtic Comm Exch - All Plans | $10,072 | 177% |
| Partners Direct Health - All Plans | $11,100 | 196% |
| Multiplan - All Plans | $12,073 | 213% |
| Midlands Choice - All Plans | $12,744 | 225% |
| Health Partners - All Plans | $12,744 | 225% |
Consumer Guidance & Cost Commentary
For the procedure code 392, representing an inpatient stay for digestive disorders treatment at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median price is $12,073. This cash rate is notably lower than the median negotiated rates paid by major payers, such as Aetna and Celtic Comm Exch, which range from $9,248 to $11,403 depending on the specific plan. While the facility's cash price aligns with the state average for this service, patients with high-deductible plans may find paying out-of-pocket initially more cost-effective, as the cash rate avoids the administrative overhead and markup inherent in insurance billing cycles. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate, as these upfront payment incentives can significantly reduce the final bill.
The facility's negotiated rates vary considerably across different insurance carriers, with the lowest allowed amount being $7,365 for Blue Cross Blue Shield and the highest at $12,744 for Midlands Choice and Health Partners. This disparity highlights that being in-network does not guarantee the best price, as commercial rates can fluctuate based on individual contract terms and network tiering. Furthermore, the Medicare benchmark for this service is $5,675.87, which serves as a critical baseline for evaluating the facility's pricing; the cash rate of $12,073 represents a significant markup over the federal government's cost-based reimbursement. To avoid unexpected costs, patients should review their specific plan