CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Piedmont Athens Regional Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $10,954
Cash Discount Price: $9,350
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Piedmont Athens Regional Medical Center is $10,954. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,350. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.93x the Medicare baseline. Located in 1199 Prince Avenue, Athens, GA.

Cash / Self-Pay

$9,350

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,954

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: $9,350 (165%)

Insurance Median: $10,954 (193%)

Cash: $9,350 (165% of Medicare)

Ins. Median: $10,954 (193% 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
Ambetter / Centene	$5,456	96%
Medicare (plans)	$7,735 - $8,036	136%
UnitedHealthcare	$7,848 - $16,741	138%
Clear Spring Health Care [30192]	$7,960	140%
Georgia Health Advantage [30143]	$8,036	142%
Blue Cross Blue Shield	$10,954 - $21,722	193%
Aetna	$11,807	208%
Cigna	$11,846 - $18,384	209%
Alliant Health Plans Of Georgia [10952]	$15,476	273%
Alliant Solocare [11101]	$16,244	286%
Caresource Marketplace [11106]	$17,152	302%

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 $9,350.
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 Piedmont Athens Regional Medical Center 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.