CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Saint Thomas Highlands Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 392
  • Insurance Median: $9,537
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.68x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Saint Thomas Highlands Hospital is $9,537. 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 1.68x the Medicare baseline. Located in 401 Sewell Dr, Sparta, TN.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$9,537

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: $9,537 (168%)
Ins. Median: $9,537 (168% 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.

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
Blue Cross Blue Shield $1,047 - $18,832 18%
Amerigroup Mcaid Replacement $2,813 - $3,568 50%
Community Plan $3,684 65%
Point Comfort Underwriters $5,273 93%
Amerigroup Mcr Replacement $5,858 103%
Ascension Complete $5,858 103%
Centurion Of Tn $5,858 103%
Covid Uninsured Test Fund $5,858 103%
Healthspring Mcr Replacement $5,858 103%
Humana $5,858 103%
Medicare (plans) $5,858 103%
Nhc Advantage $5,858 103%
UnitedHealthcare $5,858 - $15,974 103%
Aetna $5,976 - $20,300 105%
Ambetter / Centene $7,616 134%
Smart Health $8,003 - $10,900 141%
Oscar Health $8,394 - $9,510 148%
Cigna $8,625 - $16,559 152%
Health 2 Business $9,742 - $11,201 172%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 401 Sewell Dr, Sparta, TN 38583
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals