CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: UPMC Hamot

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,712
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at UPMC Hamot is $7,712. 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 1.36x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,712

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: $7,712 (136%)

Ins. Median: $7,712 (136% 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
UnitedHealthcare	$7,126 - $7,677	126%
Blue Cross Blue Shield	$7,175 - $16,405	126%
Fidelis	$7,175	126%
Independent Health	$7,264	128%
Aetna	$7,318	129%
Wellcare	$7,390	130%
Upmc Health Plan	$7,654 - $8,466	135%
Highmark Wholecare (Prev Gateway)	$7,748	137%
Amerihealth Caritas	$7,749	137%
Cigna	$7,749	137%
Pa Health & Wellness	$7,749	137%
Univera	$7,892	139%
Upmc Work Partners	$9,495	167%

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 UPMC Hamot 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.