CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Nemours Childrens Hospital, Florida

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $8,251
Cash Discount Price: $51,564
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Nemours Childrens Hospital, Florida is $8,251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51,564. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.45x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$51,564

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,251

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: $51,564 (908%)

Insurance Median: $8,251 (145%)

Cash: $51,564 (908% of Medicare)

Ins. Median: $8,251 (145% 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
Humana	$2,283	40%
Simply Health	$2,283	40%
Sunshine State	$2,283	40%
Truli	$5,966	105%
Florida Blue	$6,834 - $14,968	120%
Avmed	$12,440	219%
Evolutions Healthcare	$14,423	254%
Aetna	$14,954	263%
UnitedHealthcare	$16,135	284%
Cigna	$16,581	292%

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 $51,564.
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 Nemours Childrens Hospital, Florida 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.