CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $170
Cash Discount Price: $513
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at UMass Memorial Healthalliance Hospitals is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $513. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.45x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$513

Average discount available for prompt cash payment at this facility.

Insurance Median

$170

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $513 (436%)

Insurance Median: $170 (145%)

Cash: $513 (436% of Medicare)

Ins. Median: $170 (145% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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
Tufts [11201]	$23	20%
Cigna	$25 - $162	21%
Wellpoint [11112]	$61	52%
Workers Compensation [20501]	$100	85%
Champva [11001]	$138	117%
Harvard Pilgrim [10701]	$145	123%
Institution [10406]	$160 - $280	136%
Medicare (plans)	$160 - $162	136%
Tufts Dual [10111]	$160 - $162	136%
Correctional Care [11003]	$162	138%
Medicaid / KanCare	$162 - $275	138%
Tufts Us Family [11203]	$162	138%
Blue Cross Blue Shield	$165 - $167	140%
Aetna	$168 - $345	143%
Commonwealth Care Mcr [10115]	$168 - $170	143%
Fallon Mcr Supp [20202]	$168 - $170	143%
Mgb Mcr [10124]	$168 - $170	143%
Tufts Mcr [10112]	$168 - $170	143%
UnitedHealthcare	$169 - $528	144%
Harvard Pilgrim Mcr [10106]	$170	145%
Senior Whole Health [10110]	$173	147%
Tufts Connectorcare [10507]	$271 - $275	231%
Hsno/Free Care [10801]	$294	250%
First Health Network [11120]	$374 - $396	318%
Multiplan [11109]	$374 - $396	318%
Connecticare [11105]	$498 - $528	424%
Fallon Carelon Hlth [28]	$498 - $528	424%
Fallon Mcaid Carelon Hlth [29]	$498 - $528	424%
Grants [20507]	$498 - $528	424%

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 $513.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.