CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Paoli Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 392
  • Insurance Median: $6,281
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Paoli Hospital is $6,281. 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 1.11x the Medicare baseline. Located in 255 West Lancaster Avenue, Paoli, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$6,281

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: $6,281 (111%)
Ins. Median: $6,281 (111% 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.

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 $5,710 - $14,503 101%
Mercy Life $5,710 101%
UnitedHealthcare $5,710 - $6,372 101%
Humana $5,824 103%
Keystone First $5,824 103%
Devoted Health $6,109 108%
Health Partners/Jefferson Health $6,138 108%
Aetna $6,224 - $15,300 110%
Pa Health & Wellness $6,281 111%
Provider Partners Health Plan $6,281 111%
Upmc $6,281 111%
Highmark Wholecare $6,338 112%
Geisinger Health $6,395 113%
Cigna $12,173 214%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 255 West Lancaster Avenue, Paoli, PA 19301
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals