CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Sherman Oaks Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,766
Cash Discount Price: $7,613
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Sherman Oaks Hospital is $7,766. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,613. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.37x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$7,613

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,766

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: $7,613 (134%)

Insurance Median: $7,766 (137%)

Cash: $7,613 (134% of Medicare)

Ins. Median: $7,766 (137% 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
Aids Healthcare Foundation	$7,614 - $7,766	134%
Alignment	$7,614	134%
Blue Shield Of Ca, Va	$7,614	134%
Elite Health Plan	$7,614	134%
Health Net Of Ca	$7,614 - $13,796	134%
Imperial Health Plan	$7,614	134%
L.A Care Health Plan	$7,614	134%
Managed Health Network	$7,614	134%
Medicare (plans)	$7,614	134%
Molina	$7,614	134%
Renal Payer Solutions	$7,614	134%
Tricare	$7,614 - $7,747	134%
Usa Senior Care Network	$7,614	134%
Brand New Day	$7,690	135%
Corvel	$8,680	153%
Zelis Healthcare	$8,680	153%
Aetna	$8,862	156%
Americas Choice Provider Network	$8,862	156%
Multiplan	$8,862	156%
Prime Health Services	$8,862	156%
Three Rivers	$8,862	156%
Healthsmart Preferred Network	$8,954	158%
Provider Select	$9,045	159%
Provider Network Of America	$9,136	161%
Employer Direct Healthcare	$9,898	174%
Naphcare	$11,801	208%
National Healthcare Solutions, Inc (Nhsi)	$12,182	215%
Ca Foundation For Medical Center	$13,349	235%
Worker Comp	$13,349	235%

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 $7,613.
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 Sherman Oaks 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.