CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Southcoast Hospitals Group

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $265
Cash Discount Price: $235
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Southcoast Hospitals Group is $265. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $235. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.78x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$235

Average discount available for prompt cash payment at this facility.

Insurance Median

$265

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $235 (247%)

Insurance Median: $265 (278%)

Cash: $235 (247% of Medicare)

Ins. Median: $265 (278% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 278% of the Medicare baseline (a markup of 178%). 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
Blue Cross Blue Shield	$99 - $111	104%
Wellsense Health Plan Clarity Connectorcare & Meta	$100	105%
Medicare (plans)	$116	122%
Wellpoint [1000102]	$130	137%
Wellsense Health Plan [1010202]	$147	154%
Tufts Health Public Plans [1010213]	$169 - $412	178%
Tufts [1010701]	$196	206%
UnitedHealthcare	$219 - $335	230%
Mass General Brigham Health Plan Commercial [10122	$265	278%
Mass General Brigham Health Plan Connectorcare [10	$265	278%
Harvard Pilgrim [1010602]	$271 - $389	285%
Group Insurance Service Center [1013001]	$282	296%
Innovative Health Plan [1025001]	$282	296%
Priority Health [1015001]	$282	296%
PHCS [1000125]	$306	321%
First Health [1000130]	$358	376%

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 $235.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 CPT code 99213.
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.