CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Prisma Health Tuomey Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,271
Cash Discount Price: $14,994
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Prisma Health Tuomey Hospital is $7,271. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,994. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.28x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$14,994

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,271

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: $14,994 (264%)

Insurance Median: $7,271 (128%)

Cash: $14,994 (264% of Medicare)

Ins. Median: $7,271 (128% 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
Medicaid / KanCare	$2,031	36%
UnitedHealthcare	$2,031 - $14,148	36%
Blue Cross Blue Shield	$6,610 - $24,266	116%
Bluechoice [810]	$6,610 - $23,658	116%
Cigna	$6,925 - $15,923	122%
Humana	$6,925	122%
Medicare (plans)	$6,925 - $7,271	122%
Ambetter / Centene	$7,140	126%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904]	$7,140	126%
Triwest Healthcare Alliance Vcp [902]	$7,140	126%
Va Community Care Network-Vaccn [903]	$7,140	126%
Aetna	$7,271	128%
Healthy Conn Prime-First Choice Vip Care [5300]	$7,271	128%
Healthy Conn Prime-Molina Healthcare [5330]	$7,271	128%
Healthy Conn Prime-Wellcare Prime By Atc [5310]	$7,271	128%
Scdc-Sc Dept Of Corrections [7232]	$8,713	154%
Workers Comp [600]	$9,694	171%
Bob Jones Univ-Pai [821]	$10,382	183%
Preferred Administrators Contracted [2839]	$13,844	244%
Golden Rule Insurance Company [2991]	$14,148	249%
Oxford Health Plans [2992]	$14,148	249%
Zzumr-Salt Lake City Ut [3169]	$14,148	249%
Promise Health Plan Contracted [2401]	$15,202	268%
Planned Administrators [820]	$24,266	428%

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 $14,994.
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 Prisma Health Tuomey 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.