CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Pennsylvania Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 392
  • Insurance Median: $11,188
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.97x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Pennsylvania Hospital is $11,188. 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 1.97x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$11,188

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: $11,188 (197%)
Ins. Median: $11,188 (197% 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
UnitedHealthcare $3,308 - $17,157 58%
Penn Life (Living Independently For Elders) $6,877 121%
Ibc $6,898 122%
Blue Cross Blue Shield $6,951 - $18,544 122%
Medicare (plans) $6,951 - $7,879 122%
Upmc $6,951 122%
Cigna $7,160 - $16,434 126%
Geisinger Health Plan $7,160 - $23,501 126%
Health Partners $7,160 126%
Humana $7,160 126%
Keystone First $7,299 129%
Pa Health And Wellness $7,299 - $13,000 129%
Aetna $7,368 - $13,514 130%
Clover Health Plan $7,368 130%
Gateway Health Plan $7,600 134%
Philadelphia Va Medical Center $7,879 139%
Us Family Health Plan $10,283 181%
Ibc Commercial Hpn $11,054 195%
Elap $11,188 197%
Claims Watcher $12,606 - $14,181 222%
Oscar Health Plan $13,394 236%
Centivo $14,181 250%
Elap Services $14,654 258%
Keystone Hmo Proactive $15,107 266%
Highmark $15,632 275%
Olympus $17,378 306%
Qualcare $18,529 326%
Pgm - Embassy Of Qatar $19,097 336%
Pgm - Embassy Of The United Emirates/Ipc $20,566 362%
Penn Global Medicine $20,878 368%
Workers Compensation $29,380 518%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 800 Spruce Street, Philadelphia, PA 19107
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals