CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Sky Lakes Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $8,396
Cash Discount Price: $16,689
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Sky Lakes Medical Center is $8,396. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,689. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.48x the Medicare baseline. Located in 2865 Daggett Avenue, Klamath Falls, OR.

Cash / Self-Pay

$16,689

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,396

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%)

Cash / Self-Pay: $16,689 (294%)

Insurance Median: $8,396 (148%)

Cash: $16,689 (294% of Medicare)

Ins. Median: $8,396 (148% 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
Cco Cascade Health Alliance [5006]	$4,348	77%
Scan Health Plan [7024]	$8,396	148%
Wellcare Healthnet Med Adv HMO [7022]	$8,396	148%
Pacificsource Med Adv PPO [7018]	$8,396	148%
Blue Cross Blue Shield	$8,396 - $16,055	148%
Pyramid Todays Option Premier [7015]	$8,396	148%
Pacificsource Med Adv HMO [7035]	$8,396	148%
Alignment Health Plan [7029]	$8,396	148%
Cigna	$8,396	148%
Allcare Advantage [7006]	$8,396	148%
Kaiser Med Adv So California HMO [7038]	$8,396	148%
Kaiser Med Adv Senior Nw [7028]	$8,396	148%
Humana	$8,396	148%
Aetna	$8,396	148%
Managed Hlth Netwrk Bh Wellcare [7042]	$8,396	148%
UnitedHealthcare	$8,396	148%
Kaiser Med Adv Oregon HMO [7009]	$8,396	148%
Regence Medadvantage [7017]	$8,396	148%
Medicare (plans)	$8,396 - $8,456	148%
Kaiser Med Adv HMO [7027]	$8,396	148%
Samaritan Health Med Adv HMO [7043]	$8,396	148%
Kaiser Med Adv No California HMO [7037]	$8,396	148%
Wellcare Healthnet Med Adv PPO [7023]	$8,396	148%
Providence Health Plan [1078]	$12,962	228%
Moda Health [1070]	$18,304	322%

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 $16,689.
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 Sky Lakes Medical Center 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.