Digestive disorders treatment (inpatient stay)
Facility: Hiawatha Community Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $14,556
- Cash Discount Price: $21,420
- vs. Medicare Baseline: 2.56x 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 256% of the Medicare baseline (a markup of 156%). 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 |
|---|---|---|
| Wppa Providrs Care - All Plans | $2,962 | 52% |
| Healthy Blue Mcaid - All Plans | $3,495 | 62% |
| Blue Cross Blue Shield | $6,813 - $7,171 | 120% |
| Humana | $10,872 | 192% |
| Aetna | $10,872 - $17,950 | 192% |
| UnitedHealthcare | $10,872 - $18,399 | 192% |
| Ambetter / Centene | $13,046 | 230% |
| Oscar - All Plans | $16,065 | 283% |
| Centrus Health Direct - All Plans | $17,136 | 302% |
| Preferred Hlth - All Plans | $19,278 | 340% |
| Cigna | $20,349 | 359% |
| Multiplan - All Plans | $20,777 | 366% |
| Midlands Choice - All Plans | $20,777 | 366% |
Consumer Guidance & Cost Commentary
For the procedure "Digestive disorders treatment (inpatient stay)" at Hiawatha Community Hospital in Hiawatha, KS, the cash median price is $21,420.00, which matches the facility's gross charge. This rate is significantly higher than the Medicare benchmark of $5,675.87, reflecting a markup of 2.6 times the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates vary widely; for instance, Wppa Providers Care pays $2,962 while Cigna pays $20,349 for the same service. Because commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40%, patients with high-deductible plans might find that paying the cash price directly is more cost-effective than relying on insurance, especially if the insurer's allowed amount exceeds the cash rate.
To minimize out-of-pocket costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% for upfront payments. These discounts bypass the costly claims processing cycle and administrative labor associated with insurance billing, potentially saving patients hundreds of dollars per claim. Additionally, since over 80% of hospital bills contain errors, patients should request a full itemized CPT-coded bill before making any payments to identify unbundled codes or services not rendered. It is also important to verify the specific negotiated rates for your insurance plan, as in-network status does not guarantee the lowest possible price, and some facilities charge significantly more than