CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Southcoast Hospitals Group

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,941
Cash Discount Price: $27,484
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Southcoast Hospitals Group is $20,941. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,484. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.49x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$27,484

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,941

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $27,484 (196%)

Insurance Median: $20,941 (149%)

Cash: $27,484 (196% of Medicare)

Ins. Median: $20,941 (149% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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
Wellsense Health Plan Clarity Connectorcare & Meta	$2,194 - $10,919	16%
Wellsense Health Plan [1010202]	$6,798 - $11,957	48%
Tufts Health Public Plans [1010213]	$7,818 - $13,751	56%
Medicare (plans)	$13,747 - $20,180	98%
Mass General Brigham Health Plan Commercial [10122	$14,429 - $20,941	103%
Mass General Brigham Health Plan Connectorcare [10	$14,429 - $20,941	103%
Aetna	$17,548 - $47,256	125%
Blue Cross Blue Shield	$17,548 - $21,906	125%
Evercare [1010304]	$17,548	125%
Tufts Senior Care Options [1010315]	$17,548	125%
UnitedHealthcare	$17,548 - $41,722	125%
Wellsense Health Plan Senior Care Options [1020208	$17,723	126%
Commonwealth Care Alliance [1080501]	$18,074 - $18,250	129%
Eternal Health [1010322]	$19,302	137%
Wellpoint [1000102]	$22,178	158%
Fallon [1000114]	$24,567	175%
Tufts [1010701]	$30,943 - $36,020	220%
Cigna	$36,935 - $42,994	263%
First Health [1000130]	$40,596 - $47,256	289%
Group Insurance Service Center [1013001]	$42,454 - $49,418	302%
Innovative Health Plan [1025001]	$42,454 - $49,418	302%
PHCS [1000125]	$42,454 - $49,418	302%
Priority Health [1015001]	$42,454 - $49,418	302%

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 $27,484.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

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 470.
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.