CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $16,986
Cash Discount Price: $8,821
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Carilion Medical Center is $16,986. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,821. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.99x the Medicare baseline. Located in 1906 Belleview Avenue, Se, Roanoke, VA.

Cash / Self-Pay

$8,821

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,986

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: $8,821 (155%)

Insurance Median: $16,986 (299%)

Cash: $8,821 (155% of Medicare)

Ins. Median: $16,986 (299% 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 299% of the Medicare baseline (a markup of 199%). 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
Aetna	$6,258 - $16,734	110%
Humana	$6,524 - $23,451	115%
Blue Cross Blue Shield	$6,791 - $19,547	120%
UnitedHealthcare	$6,857 - $20,600	121%
Sentara Health Plan	$6,990 - $15,625	123%
Vhn - Ultra	$15,625	275%
Cigna	$16,986 - $18,145	299%
Gateway - Tier 3	$17,137	302%
Connecticare	$17,641	311%
Vhn - Plus	$19,405	342%
Gateway - Tier 2	$20,161	355%
Vhn	$20,161	355%
Vhn - Link	$22,682	400%
Gateway - Tier 1	$23,942	422%
Vhn - Secondary Payors	$23,942	422%

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 $8,821.
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 Carilion 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.