CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Southcoast Hospitals Group

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $42,440
Cash Discount Price: $42,999
vs. Medicare Baseline: 3.31x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Southcoast Hospitals Group is $42,440. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,999. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 3.31x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$42,999

Average discount available for prompt cash payment at this facility.

Insurance Median

$42,440

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12,807.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12,807.1 (100%)

Cash / Self-Pay: $42,999 (336%)

Insurance Median: $42,440 (331%)

Cash: $42,999 (336% of Medicare)

Ins. Median: $42,440 (331% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12,807.1 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 331% of the Medicare baseline (a markup of 231%). 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
Tufts Health Public Plans [1010213]	$8,005 - $30,395	63%
Aetna	$16,066 - $77,586	125%
Blue Cross Blue Shield	$16,066 - $49,525	125%
Evercare [1010304]	$16,066	125%
Medicare (plans)	$16,066 - $37,525	125%
Tufts Senior Care Options [1010315]	$16,066	125%
UnitedHealthcare	$16,066 - $38,134	125%
Wellsense Health Plan Senior Care Options [1020208	$16,227	127%
Commonwealth Care Alliance [1080501]	$16,548 - $16,709	129%
Eternal Health [1010322]	$17,673	138%
Wellpoint [1000102]	$20,271	158%
Fallon [1000114]	$22,493	176%
Wellsense Health Plan Clarity Connectorcare & Meta	$24,410	191%
Wellsense Health Plan [1010202]	$26,430	206%
Mass General Brigham Health Plan Commercial [10122	$39,270	307%
Mass General Brigham Health Plan Connectorcare [10	$39,270	307%
Tufts [1010701]	$50,145 - $59,138	392%
Cigna	$59,855 - $70,588	467%
First Health [1000130]	$65,789 - $77,586	514%
Group Insurance Service Center [1013001]	$68,798 - $81,135	537%
Innovative Health Plan [1025001]	$68,798 - $81,135	537%
PHCS [1000125]	$68,798 - $81,135	537%
Priority Health [1015001]	$68,798 - $81,135	537%

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 $42,999.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 322.

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 322.
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.