Digestive disorders treatment (inpatient stay)
Facility: William Newton Hospital
Billing Code: 392 (MS-DRG)
- CPT Billing Code: 392
- Insurance Median: $7,323
- Cash Discount Price: $11,914
- vs. Medicare Baseline: 1.29x 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 |
|---|---|---|
| Ambetter / Centene | $3,495 - $7,323 | 62% |
| Blue Cross Blue Shield | $5,957 - $7,323 | 105% |
| Triwest- All Plans | $7,103 | 125% |
| UnitedHealthcare | $7,323 - $13,920 | 129% |
| Providrs Care - All Other Plans | $8,935 | 157% |
| Providrs Care Nexus | $24,363 | 429% |
Consumer Guidance & Cost Commentary
For the procedure "Digestive disorders treatment (inpatient stay)" at William Newton Hospital in Winfield, KS, the cash price is $11,914, which matches the facility's median paid amount. While the hospital's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $5,957 to $13,920, the cash price remains the lowest fixed amount listed. It is important to note that for patients with high-deductible plans, paying the cash price directly can sometimes be cheaper than the insurance negotiated rate, as the insurer may pay less than the full negotiated amount before covering the patient's deductible. Additionally, this facility is a Critical Access Hospital with government-local ownership, and while the facility holds a 4-star rating, patients should verify specific "self-pay" or "prompt-pay" discounts with the hospital before scheduling to ensure they are receiving the most favorable rate available.
When evaluating costs, it is crucial to compare these figures against the Medicare benchmark rather than the hospital's gross charges. The Medicare amount for this service is $5,675.87, and the cash price of $11,914 represents a 1.3x multiplier relative to the Medicare rate, indicating a markup consistent with commercial pricing structures. Since over 80% of hospital bills contain errors, patients should request a detailed, itemized billing audit to identify any unbundled codes or services not rendered before agreeing to payment. Furthermore, if a patient receives care from an out-of-network provider at this in-network facility, they may be subject to balance billing for the difference between the provider's full charge and the insurance allowed amount, though the