CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Penn State Health St. Joseph

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $6,886
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Penn State Health St. Joseph is $6,886. 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 1.21x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,886

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: $6,886 (121%)

Ins. Median: $6,886 (121% 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
[Ibc]	$6,099 - $6,852	107%
[Highmark]	$6,784 - $16,846	120%
Aetna	$6,852 - $14,269	121%
UnitedHealthcare	$6,852 - $16,328	121%
[Amerihealth Caritas]	$6,852	121%
[Cbc]	$6,852 - $14,704	121%
[Geisinger]	$6,852	121%
[Highmark Wholecare]	$6,852	121%
Humana	$6,921	122%
[Healthspring]	$6,921	122%
[Health Partners Plans]	$6,989	123%
[Pa Health & Wellness]	$7,058	124%
[Upmc]	$7,195	127%
[Point Comfort Underwriters]	$8,565	151%
[Highmark Choice Blue]	$13,477	237%
[Highmark Aca]	$14,151	249%
Cigna	$15,226	268%

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 Penn State Health St. Joseph 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.