CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Mercy Health - Defiance Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $5,571
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Mercy Health - Defiance Hospital is $5,571. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 0.98x the Medicare baseline. Located in 1404 East Second Street, Defiance, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,571

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Insurance Median: $5,571 (98%)

Ins. Median: $5,571 (98% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$5,571	98%
Blue Cross Blue Shield	$5,571 - $13,324	98%
Buckeye Mycare Benefits [4237]	$5,571	98%
Humana	$5,571	98%
Medigold [4435]	$5,571	98%
Paramount Elite [3723]	$5,571	98%
UnitedHealthcare	$5,571 - $10,135	98%
Devoted Health Plan [4501]	$5,626	99%
Caresource Mycare Ohio [4236]	$5,682	100%
Medicare (plans)	$5,682	100%
Molina Mycare Ohio [4235]	$5,849	103%
Caresource [4179]	$8,077	142%
Buckeye [4178]	$8,635	152%
Molina Marketplace Aca [4181]	$9,749	172%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Health - Defiance Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.