CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Tufts Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,840
Cash Discount Price: $12,248
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Tufts Medical Center is $7,840. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,248. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.38x the Medicare baseline. Located in 800 Washington Street, Boston, MA.

Cash / Self-Pay

$12,248

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,840

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: $12,248 (216%)

Insurance Median: $7,840 (138%)

Cash: $12,248 (216% of Medicare)

Ins. Median: $7,840 (138% 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
UnitedHealthcare	$4,284 - $10,061	75%
Health Safety Net [500011]	$7,050	124%
Fallon Senior [450065]	$7,147 - $7,691	126%
Cigna	$7,691 - $15,754	136%
Harvard Pilgrim Stride [450060]	$7,691	136%
Humana	$7,691	136%
Martins Point Generations Replacement [450057]	$7,691	136%
Medicare (plans)	$7,691 - $10,061	136%
Neighborhood Pace [450114]	$7,691	136%
Peak Pace Solutions [450115]	$7,691	136%
Secure Horizons Ma Pffs [450077]	$7,691	136%
Aetna	$7,840 - $12,718	138%
Blue Cross Blue Shield	$7,840	138%
Commonwealth Care Alliance [450067]	$7,840	138%
Medicaid / KanCare	$7,840 - $10,061	138%
Meritain [100063]	$9,867	174%
Veterans Evaluation Svcs [800004]	$9,870	174%
Champva [800006]	$10,061	177%
Veterans Services [800005]	$10,061	177%
Elementcare [450046]	$12,343	217%
Wellpoint [100139]	$16,174	285%
Fallon Health Connectorcare [100260]	$18,210	321%
Fallon Health [100259]	$18,210	321%

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 $12,248.
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 Tufts Medical Center 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.