CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Good Samaritan Hospital of Suffern

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $10,823
Cash Discount Price: $10,940
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Good Samaritan Hospital of Suffern is $10,823. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,940. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.91x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

$10,940

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,823

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: $10,940 (193%)

Insurance Median: $10,823 (191%)

Cash: $10,940 (193% of Medicare)

Ins. Median: $10,823 (191% 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
First Health	$1,664	29%
Multiplan	$5,836	103%
Tricare	$7,114	125%
Aetna	$7,294 - $22,557	129%
Blue Cross Blue Shield	$7,294	129%
Cdphp	$7,294	129%
Emblem	$7,294 - $31,797	129%
Fidelis	$7,294	129%
Geisinger	$7,294 - $16,557	129%
Hamaspik	$7,294	129%
Magnacare	$7,294 - $29,687	129%
Mvp	$7,294 - $25,360	129%
Non Contracted	$7,294	129%
Oxford	$7,294 - $21,013	129%
Partners Health Plan	$7,294	129%
UnitedHealthcare	$7,294 - $21,013	129%
Wellcare	$7,294	129%
Health First	$7,804	137%
World Trade Center	$10,823	191%
Cigna	$24,179	426%

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 $10,940.
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 Good Samaritan Hospital of Suffern 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.