CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Holy Family Memorial

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $10,854
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Holy Family Memorial is $10,854. 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 1.91x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,854

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: $10,854 (191%)

Ins. Median: $10,854 (191% 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
Blue Cross Blue Shield	$5,457 - $13,724	96%
Community Care Incorporated	$5,457	96%
Health Partners	$5,457 - $15,884	96%
Humana	$5,457	96%
Icare	$5,457	96%
Molina	$5,457 - $5,893	96%
Network Health Plan	$5,457 - $14,618	96%
Security Health Plan	$5,457	96%
UnitedHealthcare	$5,457 - $22,970	96%
Allwell	$5,566	98%
Health Payment Systems	$10,068	177%
Chorus Community Health Plan	$10,722	189%
Wps Health Plan	$10,986	194%
Dean Health Plan	$13,568	239%
Centivo	$14,533 - $17,588	256%
Medical College Of Wisconsin	$15,707	277%

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 Holy Family Memorial 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.