CMS Price Transparency Data
Digestive disorders treatment (inpatient stay)
Facility: Chilton Medical Center
Billing Code: 392 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 392
- Insurance Median: $15,000
- Cash Discount Price: $8,226
- vs. Medicare Baseline: 2.64x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Chilton Medical Center is $15,000. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,226. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.64x the Medicare baseline. Located in 97 West Parkway, Pompton Plains, NJ.
Cash / Self-Pay
$8,226
Average discount available for prompt cash payment at this facility.
Insurance Median
$15,000
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: $8,226 (145%)
Insurance Median: $15,000 (264%)
Cash: $8,226 (145% of Medicare)
Ins. Median: $15,000 (264% 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 264% of the Medicare baseline (a markup of 164%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Karen Ann Quinlan [5285] | $5,265 | 93% |
| Champva [5354] | $5,896 | 104% |
| Tricare | $5,896 | 104% |
| Us Family Health Plan [5258] | $5,896 | 104% |
| Aetna | $5,923 - $15,589 | 104% |
| Cigna | $6,581 - $20,001 | 116% |
| Medicare (plans) | $6,581 - $7,239 | 116% |
| VA Community Care Network [5403] | $6,581 | 116% |
| Qualcare [5026] | $6,614 - $17,769 | 117% |
| Amerihealth Administrators Supplemental [5512] | $6,713 | 118% |
| Amerihealth Medigap [5049] | $6,713 | 118% |
| Wellcare Behavioral Health [5335] | $7,042 | 124% |
| Wellcare Health Plans Ip Splits [5475] | $7,042 | 124% |
| Wellcare Health Plans [5269] | $7,042 | 124% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $7,239 | 128% |
| Highmark Wholecare Health Plan [5413] | $7,239 | 128% |
| Kindred Giralda Hospital [5341] | $7,239 | 128% |
| UPMC [5455] | $7,239 | 128% |
| Occunet [5490] | $7,532 | 133% |
| The Fairly Group [5528] | $7,532 | 133% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $7,568 | 133% |
| Medicaid / KanCare | $7,568 | 133% |
| Specialty Imaging [5433] | $7,568 | 133% |
| Sedgwick Wtc Health Program Wc [5514] | $8,226 | 145% |
| Praxis Workers Comp [5515] | $8,500 | 150% |
| Inservco Workers Compensation [5158] | $8,682 | 153% |
| Medlogix/Consumer Health Network (Chn) [5415] | $8,682 | 153% |
| Gallagher Bassett Workers Comp [5117] | $9,028 | 159% |
| Liberty Mutual Worker's Comp [5174] | $9,028 | 159% |
| Pma Workers Comp [5224] | $9,028 | 159% |
| Sedgwick [5235] | $9,028 | 159% |
| Sentry Worker's Comp [5489] | $9,028 | 159% |
| Travelers Workers Compensation [5250] | $9,028 | 159% |
| Kessler Foundation [5532] | $12,000 | 211% |
| Claim Watcher/Homestead [5488] | $12,504 | 220% |
| Fairos [5491] | $12,570 | 221% |
| Ambetter / Centene | $13,557 | 239% |
| Claimdoc [5434] | $14,544 | 256% |
| 1199 Seiu Benefit and Pension [5037] | $15,589 | 275% |
| Allied Benefit Systems [5046] | $15,589 - $20,001 | 275% |
| Banner Health Network [5510] | $15,589 | 275% |
| Boon-Chapman [5441] | $15,589 | 275% |
| Christian Brothers Services [5439] | $15,589 | 275% |
| Continental Assurance [5091] | $15,589 | 275% |
| Evolution Healthcare [5438] | $15,589 - $18,183 | 275% |
| Healthez [5445] | $15,589 - $18,183 | 275% |
| Healthsmart Benefit Solutions [5446] | $15,589 | 275% |
| Luminare Health Benefits [5483] | $15,589 | 275% |
| Marpai Health [5449] | $15,589 | 275% |
| Meritain Health [5185] | $15,589 | 275% |
| Nippon Benefit Life [5201] | $15,589 | 275% |
| Starmark [5240] | $15,589 | 275% |
| Webtpa [5447] | $15,589 - $18,183 | 275% |
| Blue Cross Blue Shield | $16,085 - $17,484 | 283% |
| Independence Bc [5479] | $17,484 | 308% |
| Prime Healthcare [5435] | $17,484 | 308% |
| Ghi Emblem Health [5122] | $17,769 | 313% |
| Humana | $17,769 | 313% |
| Ila Local 1478-2 Welfare Fund [5448] | $17,769 | 313% |
| Oscar [5213] | $17,769 | 313% |
| Mvp Health Care [5197] | $18,183 | 320% |
| Nalc [5198] | $18,183 | 320% |
| Tufts Health Plan [5344] | $18,183 | 320% |
| Centivo [5405] | $18,463 - $20,001 | 325% |
| Oxford Behavioral Health [5291] | $19,602 | 345% |
| Oxford [5024] | $19,602 | 345% |
| UnitedHealthcare | $19,602 - $20,209 | 345% |
| Iaa - Insurance Administrators of America [5482] | $20,001 | 352% |
| Apwu Healthcare [5053] | $20,209 | 356% |
| Geha [5119] | $20,209 | 356% |
| Golden Rule Insurance [5124] | $20,209 | 356% |
| Harvard Pilgrim Healthcare [5133] | $20,209 | 356% |
| Ntca [5208] | $20,209 | 356% |
| Surest [5437] | $20,209 | 356% |