CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Cambridge Health Alliance

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $17,502
Cash Discount Price: $31,696
vs. Medicare Baseline: 3.08x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Cambridge Health Alliance is $17,502. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31,696. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 3.08x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$31,696

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,502

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: $31,696 (558%)

Insurance Median: $17,502 (308%)

Cash: $31,696 (558% of Medicare)

Ins. Median: $17,502 (308% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 308% of the Medicare baseline (a markup of 208%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aarp [40001]	$2,950 - $15,752	52%
Oxford Health [40004]	$2,950	52%
United Medical Resource [40005]	$2,950	52%
UnitedHealthcare	$2,950 - $15,752	52%
Cigna	$3,353 - $17,502	59%
Aetna	$3,800 - $17,502	67%
Wellpoint [50012]	$5,126	90%
Other Tufts Health Public Plan [75002]	$9,239 - $28,248	163%
Blue Cross Blue Shield	$17,502	308%
Boston Medical Center - Wellsense [50003]	$17,502	308%
Commonwealth Care Alliance [65001]	$17,502	308%
Elder Service Plan [65002]	$17,502	308%
Health Safety Net [80001]	$17,502	308%
Hphc [20001]	$17,502	308%
Humana	$17,502	308%
Other Commercial Payor [50015]	$17,502	308%
Senior Whole Health [65003]	$17,502	308%
Tufts Health Plan [30001]	$17,502	308%
Champva [85001]	$18,875	333%
Medicare (plans)	$18,875	333%
Other Gov'T Payor [85003]	$18,875	333%
Tricare	$18,875	333%
Fallon [50006]	$22,650	399%

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 $31,696.
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 Cambridge Health Alliance 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.