CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Charleston Area Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $14,869
Cash Discount Price: $49,154
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Charleston Area Medical Center is $14,869. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49,154. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.62x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$49,154

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,869

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: $49,154 (866%)

Insurance Median: $14,869 (262%)

Cash: $49,154 (866% of Medicare)

Ins. Median: $14,869 (262% 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 262% of the Medicare baseline (a markup of 162%). 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	$4,711 - $48,170	83%
The Health Plan Of West Virginia Inc.	$4,711 - $47,679	83%
Unicare Health Plan Of West Virginia Inc.	$4,711	83%
Triwest Va	$5,151	91%
Blue Cross Blue Shield	$5,310 - $44,823	94%
Choicecare Network	$5,310 - $48,170	94%
Optimum Choice Inc.	$5,310	94%
UnitedHealthcare	$5,470 - $48,170	96%
West Virginia Senior Advantage Inc.	$5,576	98%
Integrated Medical Solutions	$7,700	136%
Naphcare	$10,621	187%
Caresource	$14,869	262%
Tricare	$29,492	520%
City Of Charleston	$36,865	650%
Cigna	$45,713	805%
Three Rivers Providers Network	$47,679	840%
Healthsmart	$48,170	849%
Multiplan	$48,170	849%

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 $49,154.
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 Charleston Area 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.