CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Hospital for Special Surgery

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $21,997
Cash Discount Price: $28,376
vs. Medicare Baseline: 3.88x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Hospital for Special Surgery is $21,997. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28,376. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 3.88x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$28,376

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,997

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: $28,376 (500%)

Insurance Median: $21,997 (388%)

Cash: $28,376 (500% of Medicare)

Ins. Median: $21,997 (388% 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 388% of the Medicare baseline (a markup of 288%). 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
Emblem Health [1043]	$4,735 - $5,474	83%
Blue Cross Blue Shield	$5,474 - $19,298	96%
Connecticare [1039]	$5,474 - $7,265	96%
Medicare (plans)	$7,265	128%
UnitedHealthcare	$7,265 - $27,469	128%
Geha [1053]	$21,997	388%
Student Resources [1103]	$21,997	388%
Oxford [1096]	$24,603	433%
Harvard Pilgrim [1057]	$27,469	484%

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 $28,376.
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 Hospital for Special Surgery 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.