CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Cannon Memorial Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $4,726
Cash Discount Price: $15,763
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Cannon Memorial Hospital is $4,726. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,763. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 0.83x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.

Cash / Self-Pay

$15,763

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,726

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: $15,763 (278%)

Insurance Median: $4,726 (83%)

Cash: $15,763 (278% of Medicare)

Ins. Median: $4,726 (83% 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
Cigna	$4,632	82%
Nhc Advantage Alt Payer [6101]	$4,632	82%
Nhc Advantage [61]	$4,632	82%
UnitedHealthcare	$4,632 - $4,726	82%
Absolute Total Care Mcr Plans Alt Payer [4101]	$4,726	83%
Absolute Total Care Mcr Plans [41]	$4,726	83%
Aetna	$4,726	83%
Ambetter / Centene	$4,726	83%
Blue Cross Blue Shield	$4,726 - $13,544	83%
Bright Health Alt Payer [1001]	$4,726	83%
Champva [604]	$4,726	83%
Continental Life Ins Co [7]	$4,726	83%
Devoted Health Alt Payer [9401]	$4,726	83%
Devoted Health [94]	$4,726	83%
Edison Health Solutions [95]	$4,726	83%
First Choice Next [96]	$4,726	83%
First Choice Vip Careplus Alt Payer [3301]	$4,726	83%
First Choice Vip [33]	$4,726	83%
Healthscope [98]	$4,726	83%
Humana	$4,726	83%
Medicare (plans)	$4,726	83%
Molina Dual Options [15]	$4,726	83%
Molina Marketplace [97]	$4,726	83%
Mutual Of Omaha [107]	$4,726	83%
Tricare	$4,726	83%
Vaccn - Va Community Care Network [16]	$4,726	83%
Veterans Administration [633]	$4,726	83%
Workers Compensation [622]	$4,726	83%
Bright Health [11]	$11,704	206%

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 $15,763.
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 Cannon Memorial 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.