CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $13,855
Cash Discount Price: $13,517
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Saint Alphonsus Medical Center Ontario is $13,855. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,517. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.44x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.

Cash / Self-Pay

$13,517

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,855

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: $13,517 (238%)

Insurance Median: $13,855 (244%)

Cash: $13,517 (238% of Medicare)

Ins. Median: $13,855 (244% 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 244% of the Medicare baseline (a markup of 144%). 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
Blue Cross Blue Shield	$7,543 - $15,044	133%
Medicare (plans)	$7,543 - $8,082	133%
UnitedHealthcare	$7,543	133%
Aetna	$7,770	137%
American Health Advantage Of Idaho	$7,845	138%
Mountain Health Co-Op	$11,905	210%
Selecthealth	$12,801 - $14,161	226%
Moda Health	$13,855	244%
Healthcare Management Admin	$14,028	247%
Blue Benefit Administrators Of Massachusetts	$15,044	265%
Blue Care Network	$15,044	265%
Blue Distinction Transplant	$15,044	265%
Blue Shield - Ca	$15,044	265%
Blue Shield - Id (Regence)	$15,044	265%
Blue Shield - Ny Highmark Northeastern	$15,044	265%
Blue Shield - Ny Highmark Western	$15,044	265%
Blue Shield - Pa (Highmark)	$15,044	265%
Blue Shield - Wa (Regence)	$15,044	265%
Webtpa	$15,394	271%

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 $13,517.
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 Alphonsus Medical Center Ontario 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.