CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Roxborough Memorial Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,876
Cash Discount Price: $7,876
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Roxborough Memorial Hospital is $7,876. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,876. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.39x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$7,876

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,876

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: $7,876 (139%)

Insurance Median: $7,876 (139%)

Cash: $7,876 (139% of Medicare)

Ins. Median: $7,876 (139% 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
Humana	$5,153	91%
Blue Cross Blue Shield	$6,708 - $9,532	118%
Health Partners Plan	$6,708 - $9,043	118%
Pa Health & Wellness	$6,708 - $9,452	118%
Ubh	$6,708 - $7,876	118%
UnitedHealthcare	$6,708 - $7,876	118%
Tricare	$6,813	120%
Keystone	$6,976	123%
Medicare (plans)	$7,043 - $7,876	124%
Providers Partner Health Plan	$8,113	143%
Spartan	$8,270	146%
Luminary	$8,439	149%
Auto Insurance	$8,664	153%
Employer Direct Healthcare	$10,239	180%
Cigna	$10,307	182%
Naphcare	$12,208	215%
Highmark	$13,503	238%
Worker Compensation	$35,257	621%

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 $7,876.
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 Roxborough Memorial Hospital 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.