CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Adventist Health Sierra Vista

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $14,103
Cash Discount Price: $5,282
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Adventist Health Sierra Vista is $14,103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,282. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.48x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$5,282

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,103

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: $5,282 (93%)

Insurance Median: $14,103 (248%)

Cash: $5,282 (93% of Medicare)

Ins. Median: $14,103 (248% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 248% of the Medicare baseline (a markup of 148%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medi-Cal	$7,477	132%
Aetna	$7,726 - $34,197	136%
Cencal Mcr Adv - All Other Plans	$7,726	136%
Tricare	$7,726	136%
UnitedHealthcare	$7,726 - $44,298	136%
Cencal Mcal	$8,524	150%
Blue Shield Promise Mcal	$8,988	158%
Ccah-Centrl Ca Allince Mcal-All Plans	$9,775	172%
Coalinga-All Plans	$10,044	177%
Ah Employee Health Plan - All Plans	$13,907	245%
Hpn-Heritage Prov Ntwrk-All Plans	$14,300	252%
Blue Shield Epn	$19,246	339%
Blue Shield Hmo/Pos	$25,340	446%
Blue Shield Epo/Ppo-All Other Plans	$26,487	467%
Nbd-Ntwrks By Design Exclus-All Other Plans	$32,491	572%
Nbd-Ntwrks By Design Non-Exclus	$39,329	693%

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 $5,282.
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 Adventist Health Sierra Vista 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.