CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Saint Anthony Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,819
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Saint Anthony Medical Center is $7,819. 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 1.38x the Medicare baseline. Located in 5666 East State Street, Rockford, IL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,819

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: $7,819 (138%)

Ins. Median: $7,819 (138% 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
Phcs	$5,847	103%
Health Alliance Plan	$6,656	117%
Humana	$6,656 - $12,822	117%
Meridian	$6,656	117%
Molina Healthcare	$6,656	117%
UnitedHealthcare	$6,656 - $13,570	117%
Aetna	$6,723 - $8,649	118%
Wellcare	$6,723	118%
Blue Cross Blue Shield	$6,789 - $10,850	120%
Zing	$6,989	123%
Caterpillar	$10,680	188%
Dean Health Plan	$11,371	200%
Cigna	$13,620	240%
Osfdan	$13,989	246%
The Alliance	$13,989	246%

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 Saint Anthony 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.