CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Clara Maass Medical Center

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $11,905
Cash Discount Price: $2,335
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Clara Maass Medical Center is $11,905. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,335. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.10x the Medicare baseline. Located in One Clara Maass Drive, Belleville, NJ.

Cash / Self-Pay

$2,335

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,905

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: $2,335 (41%)

Insurance Median: $11,905 (210%)

Cash: $2,335 (41% of Medicare)

Ins. Median: $11,905 (210% 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 210% of the Medicare baseline (a markup of 110%). 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
Wellpoint	$1,885 - $6,703	33%
Blue Cross Blue Shield	$4,682 - $14,123	82%
Qualcare Inc	$5,673 - $5,944	100%
Aetna	$6,703 - $18,308	118%
Clover Health	$6,703	118%
Fidelis Care	$6,703	118%
Humana	$6,703	118%
UnitedHealthcare	$6,837 - $19,646	120%
Emblem Health	$11,212	198%
Cigna	$12,597 - $16,858	222%
Wellcare	$13,339	235%
Amerihealth	$15,728 - $19,694	277%

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 $2,335.
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 Clara Maass 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.