CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Melrosewakefield Healthcare

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $6,985
Cash Discount Price: $8,718
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Melrosewakefield Healthcare is $6,985. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,718. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.23x the Medicare baseline. Located in 585 Lebanon Street, Melrose, MA.

Cash / Self-Pay

$8,718

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,985

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: $8,718 (154%)

Insurance Median: $6,985 (123%)

Cash: $8,718 (154% of Medicare)

Ins. Median: $6,985 (123% 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
Elementcare [450046]	$3,105	55%
Meritain [100063]	$3,984	70%
Fallon Senior [450065]	$6,553 - $6,985	115%
Champva [800006]	$6,985	123%
Cigna	$6,985	123%
Harvard Pilgrim Stride [450060]	$6,985	123%
Humana	$6,985	123%
Martins Point Generations Replacement [450057]	$6,985	123%
Medicaid / KanCare	$6,985 - $7,063	123%
Medicare (plans)	$6,985 - $7,120	123%
Neighborhood Pace [450114]	$6,985	123%
Peak Pace Solutions [450115]	$6,985	123%
Secure Horizons Ma Pffs [450077]	$6,985	123%
UnitedHealthcare	$6,985 - $7,063	123%
Veterans Evaluation Svcs [800004]	$6,985	123%
Veterans Services [800005]	$6,985	123%
Blue Cross Blue Shield	$7,063	124%
Commonwealth Care Alliance [450067]	$7,063	124%
Wellpoint [100139]	$8,307	146%
Fallon Health Connectorcare [100260]	$10,111	178%
Fallon Health [100259]	$10,111	178%
Tufts Health Public Plan Connectorcare [100264]	$11,772	207%
Health Safety Net [500011]	$12,823	226%

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 $8,718.
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 Melrosewakefield Healthcare 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.