CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Kenmore Mercy Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $5,857
Cash Discount Price: $10,792
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Kenmore Mercy Hospital is $5,857. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,792. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.03x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$10,792

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,857

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: $10,792 (190%)

Insurance Median: $5,857 (103%)

Cash: $10,792 (190% of Medicare)

Ins. Median: $5,857 (103% 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
Beacon Essential [350122]	$2,610 - $2,636	46%
Medicaid / KanCare	$2,610 - $5,857	46%
Beacon Health Options Alt [100024]	$2,610	46%
Beacon Health Options [100023]	$2,610	46%
UnitedHealthcare	$2,832 - $14,528	50%
Amerigroup [350102]	$2,832	50%
Fidelis Essential [100163]	$2,832	50%
Blue Cross Blue Shield	$2,832 - $9,246	50%
Excellus Rochester McD [350117]	$2,832	50%
Molina Essential [100167]	$2,832	50%
Independent Health Essential [100166]	$2,832 - $3,398	50%
Crime Victims [100176]	$2,832	50%
Univera Healthcare Essential [100170]	$2,832	50%
No Fault [114001]	$3,996	70%
Fidelis Exchange [100164]	$4,310	76%
Mvp Healthcare [100168]	$4,406	78%
Independent Health [100165]	$5,548 - $8,656	98%
Tricare	$5,674	100%
Champ VA [700002]	$5,674	100%
VA Veterans Affairs [700001]	$5,674 - $5,857	100%
Univera Healthcare [100169]	$5,721 - $8,174	101%
Wellcare [450129]	$5,857	103%
Fallon Health [450115]	$5,857	103%
Cigna	$5,857	103%
Medicare (plans)	$5,857	103%
Federal Workers Compensation [500100]	$5,857	103%
Fidelis Dual Advantage [450120]	$5,857	103%
Covid19 Hrsa [45013]	$5,857	103%
Seneca Nation [450119]	$5,857	103%
Catholic Health Life Pace [400005]	$5,857	103%
Wellcare Fidelis Dual [450451]	$5,857	103%
Humana	$5,857	103%
Aetna	$5,857	103%
Iha First Choice [800001]	$6,836	120%
UPMC Health Plan [100181]	$13,696	241%
Ghi [100153]	$15,052	265%

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 $10,792.
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 Kenmore Mercy 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.