CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Southcoast Hospitals Group

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $11,425
Cash Discount Price: $9,110
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Southcoast Hospitals Group is $11,425. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,110. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 2.01x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$9,110

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,425

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: $9,110 (161%)

Insurance Median: $11,425 (201%)

Cash: $9,110 (161% of Medicare)

Ins. Median: $11,425 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Medicare (plans)	$5,531 - $8,378	97%
Aetna	$7,285 - $14,286	128%
Blue Cross Blue Shield	$7,285	128%
Evercare [1010304]	$7,285	128%
Tufts Senior Care Options [1010315]	$7,285	128%
UnitedHealthcare	$7,285 - $16,863	128%
Wellsense Health Plan Senior Care Options [1020208	$7,358	130%
Commonwealth Care Alliance [1080501]	$7,504 - $7,577	132%
Eternal Health [1010322]	$8,014	141%
Wellpoint [1000102]	$8,964	158%
Tufts [1010701]	$10,021 - $10,889	177%
Fallon [1000114]	$10,199	180%
Cigna	$11,962 - $12,998	211%
First Health [1000130]	$13,148 - $14,286	232%
Group Insurance Service Center [1013001]	$13,749 - $14,940	242%
Innovative Health Plan [1025001]	$13,749 - $14,940	242%
PHCS [1000125]	$13,749 - $14,940	242%
Priority Health [1015001]	$13,749 - $14,940	242%

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 $9,110.
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 Southcoast Hospitals Group 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.