CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Ascension St Vincent Carmel

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $14,575
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Ascension St Vincent Carmel is $14,575. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.57x the Medicare baseline. Located in 13500 N Meridian St, Carmel, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,575

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%)

Insurance Median: $14,575 (257%)

Ins. Median: $14,575 (257% 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 257% of the Medicare baseline (a markup of 157%). 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
Prohealth	$7,940	140%
Suburban Tpa	$7,940	140%
Suburban/Sho	$7,940	140%
Aetna	$11,231	198%
Advantage 360	$11,500 - $12,200	203%
One Health Plan	$11,500	203%
Blue Cross Blue Shield	$11,641 - $24,983	205%
Encore	$13,400	236%
Encore Exclusive	$13,400	236%
Humana	$13,469 - $16,535	237%
Cigna	$13,479 - $19,607	237%
Smarthealth Ppo/Hdhp 20161001	$13,700	241%
Unified Zionsville	$13,965 - $14,963	246%
Siho Ppo	$15,000	264%
UnitedHealthcare	$17,634 - $19,069	311%
Unified Group Services	$18,572 - $19,901	327%
Sagamore Plus Drg	$19,607	345%

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 $X.
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 Ascension St Vincent Carmel 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.