CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Margaretville Memorial Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $5,303
Cash Discount Price: $15,279
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Margaretville Memorial Hospital is $5,303. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,279. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 0.93x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$15,279

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,303

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: $15,279 (269%)

Insurance Median: $5,303 (93%)

Cash: $15,279 (269% of Medicare)

Ins. Median: $5,303 (93% 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
Todays Options	$2,654 - $2,920	47%
Medicare (plans)	$2,654 - $3,633	47%
Non Contracted	$3,395	60%
Blue Cross Blue Shield	$3,395 - $27,677	60%
Mvp	$3,395 - $17,908	60%
Mvp Gold (McR)	$3,395	60%
Hamaspik (McR)	$3,395	60%
Magnacare	$3,395 - $6,872	60%
Aetna	$3,395 - $22,166	60%
UnitedHealthcare	$3,395 - $22,383	60%
Hamaspik	$3,395	60%
Cdphp	$3,395 - $3,735	60%
Wellcare	$3,395	60%
Affinity By Molina McR	$3,565	63%
Health First	$3,633	64%
Magnacare Preferred	$7,456	131%
Emblem	$18,404 - $31,797	324%
Oxford	$18,794 - $20,882	331%
Emblem Select Care (Exchange)	$19,215	339%
Mvp Exchange	$19,323	340%
Emblem Ghi/Hip Ppo/Cbp	$21,632	381%
Emblem Ghi/Hip Hmo/Epo/Pos	$22,606	398%
Mvp Hmo/Ppo	$22,733	401%
Self-Pay	$28,785	507%

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 $15,279.
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 Margaretville 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.