Digestive disorders treatment (inpatient stay)
Facility: Clara Barton Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $11,660
- Cash Discount Price: $9,069
- vs. Medicare Baseline: 2.05x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 205% of the Medicare baseline (a markup of 105%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $6,627 | 117% |
| 6 Degrees Health - All Plans | $9,069 | 160% |
| Wppa-All Plans | $10,364 | 183% |
| Aetna | $11,660 | 205% |
| UnitedHealthcare | $11,660 | 205% |
| Phcs - All Plans | $11,660 | 205% |
| Hlth Partners Of Ks-All Plans | $11,919 | 210% |
Consumer Guidance & Cost Commentary
For this inpatient stay at Clara Barton Hospital in Hoisington, KS, the facility's cash price of $9,069 is lower than the median negotiated rate of $11,660 paid by most major insurers, including Blue Cross Blue Shield, Aetna, and UnitedHealthcare. This difference highlights how commercial insurance contracts often include administrative overheads that can result in higher out-of-pocket costs for patients with high-deductible plans compared to self-pay options. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify their specific plan's deductible status before scheduling, as paying the cash price upfront may be more financially advantageous if their insurance allowed amount exceeds the cash rate.
The facility's negotiated rates are also notably higher than the Medicare benchmark of $5,675.87, which serves as a scientifically validated baseline for the true cost of care delivery. Although the data does not provide specific state or county average comparisons for this procedure, the significant gap between the Medicare rate and the commercial negotiated rates underscores the importance of understanding markup structures. To ensure you are not overcharged, we recommend requesting a full itemized bill to review every code and service rendered, as summary bills often obscure unbundled charges or services not delivered. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, and you should dispute any unexpected charges in writing rather than accepting summary invoices as final.