Digestive disorders treatment (inpatient stay)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $5,214
- Cash Discount Price: $6,857
- vs. Medicare Baseline: 0.92x 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 | $2,194 - $4,574 | 39% |
| UnitedHealthcare | $5,854 | 103% |
| Blue Cross Blue Shield | $7,365 | 130% |
Consumer Guidance & Cost Commentary
For the procedure "Digestive disorders treatment (inpatient stay)" at Community Memorial Healthcare, Inc. in Marysville, KS, the cash median price is $6,857.00, which matches the gross charge listed. This cash rate is significantly higher than the median negotiated rate of $5,214.00 paid by insurers, suggesting that patients with high-deductible plans might save money by paying the cash price directly, provided they qualify for the facility's self-pay or prompt-pay discounts. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price remains the baseline for uninsured patients, and commercial payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield have negotiated rates ranging from $2,194 to $7,365 depending on the specific plan.
When evaluating the cost relative to federal benchmarks, the Medicare amount for this service is $5,675.87. The cash price of $6,857.00 represents a markup of approximately 20.8% over the Medicare rate, which falls within the typical range for fair pricing (120% to 150% of Medicare) rather than the commercial average of 200% to 300%. Patients should be aware that comparing the cash price to the hospital's gross chargemaster can be misleading, as the gross charge is often inflated to make discounts appear larger; the most accurate comparison is against the Medicare benchmark. To ensure the lowest possible cost, consumers should request an itemized billing audit to verify that no unbundled codes or services not rendered are included in