CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Samaritan Hospital of Troy, New York

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $8,899
Cash Discount Price: $15,570
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Samaritan Hospital of Troy, New York is $8,899. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,570. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.57x the Medicare baseline. Located in 2215 Burdett Avenue, Troy, NY.

Cash / Self-Pay

$15,570

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,899

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: $15,570 (274%)

Insurance Median: $8,899 (157%)

Cash: $15,570 (274% of Medicare)

Ins. Median: $8,899 (157% 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
Wellpath	$3,000	53%
Blue Cross Blue Shield	$7,796 - $7,956	137%
Medicare (plans)	$7,952 - $8,888	140%
Eddy Seniorcare Pace	$7,956	140%
Secure Horizons Ma Pffs	$8,108	143%
UnitedHealthcare	$8,108 - $27,949	143%
Aetna	$8,420 - $16,751	148%
Medicaid / KanCare	$8,433	149%
Hudson Headwaters Pace	$8,592	151%
Nascentia Health Plus	$8,910	157%
Fidelis Care	$14,320	252%
1199 National Benefit Fund	$16,751	295%
Allied Benefit Systems	$16,751	295%
Asr Health Benefits	$16,751	295%
Christian Brother Services	$16,751	295%
Geha	$16,751	295%
Lucent Health	$16,751	295%
Luminare Health	$16,751	295%
Medical Mutual	$16,751	295%
Meritain	$16,751	295%
Trustmark Small Business Benefits	$16,751	295%
Capital District Physicians Health Plan	$21,558	380%
Emblem Health	$21,667	382%
Nova	$21,667	382%
Harvard Pilgrim Healthcare	$27,949	492%

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 $15,570.
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 Samaritan Hospital of Troy, New York 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.