CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 392
  • Insurance Median: $12,411
  • Cash Discount Price: $6,028
  • vs. Medicare Baseline: 2.19x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Carilion Stonewall Jackson Hospital is $12,411. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,028. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.19x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$6,028

Average discount available for prompt cash payment at this facility.

Insurance Median
$12,411

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: $6,028 (106%)
Insurance Median: $12,411 (219%)
Cash: $6,028 (106% of Medicare)
Ins. Median: $12,411 (219% 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 219% of the Medicare baseline (a markup of 119%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Blue Cross Blue Shield $5,596 - $6,216 99%
UnitedHealthcare $8,628 - $14,078 152%
Aetna $8,766 - $11,436 154%
Sentara Health Plan $10,678 188%
Vhn - Ultra $10,678 188%
Gateway - Tier 3 $11,711 206%
Connecticare $12,056 212%
Gateway - Tier 2 $13,778 243%
Vhn - Plus $13,778 243%
Cigna $13,795 243%
Integrated Health Plan $14,639 258%
Vhn $14,639 258%
Vhn - Link $15,500 273%
Beech Street $15,845 279%
Gateway - Tier 1 $16,361 288%
Vhn - Secondary Payors $16,361 288%
Humana $23,451 413%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals