Digestive disorders treatment (inpatient stay)
Facility: Memorial Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $9,213
- Cash Discount Price: $16,379
- vs. Medicare Baseline: 1.62x 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 |
|---|---|---|
| Wppa/Providers Care-All Plans | $5,457 | 96% |
| Blue Cross Blue Shield | $6,485 | 114% |
| Tricare | $9,122 | 161% |
| Humana | $9,122 | 161% |
| Medicare (plans) | $9,213 | 162% |
| Ambetter / Centene | $10,034 | 177% |
| Coventry - All Other Plans | $14,741 | 260% |
| Preferred Healthcare-All Plans | $15,560 | 274% |
| Health Partners Of Kansas - All Plans | $15,560 | 274% |
Consumer Guidance & Cost Commentary
For this inpatient digestive disorder treatment at Memorial Hospital in Abilene, KS, the cash price of $16,379 is notably higher than the facility's negotiated rate of $9,213, which represents the average amount commercial insurers pay. While the hospital is a Critical Access Hospital with a government ownership structure, the cash price remains significantly above the Medicare benchmark of $5,676. This disparity highlights that for patients with high-deductible plans who have not yet met their coverage limits, paying the cash price directly could result in lower out-of-pocket costs compared to using insurance, as the negotiated rate often exceeds the cash price due to administrative overhead and contract dynamics.
To minimize costs, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling, as these programs can reduce the final bill by 20% to 50% by bypassing insurance billing cycles and administrative fees. It is also important to verify the specific allowed amount for your plan, as in-network rates vary significantly even within the same facility, and relying on the chargemaster list as a benchmark can lead to confusion. Given that over 80% of hospital bills contain errors, consumers are advised to demand a full itemized statement before paying and to dispute any balance billing if applicable, ensuring they are only paying for services rendered at fair market rates rather than inflated list prices.