CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $7,875
Cash Discount Price: $17,834
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at UMass Memorial Health - Harrington Hospital is $7,875. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,834. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.39x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$17,834

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,875

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: $17,834 (314%)

Insurance Median: $7,875 (139%)

Cash: $17,834 (314% of Medicare)

Ins. Median: $7,875 (139% 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.

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
Fallon Carelon Hlth [28]	$1,253	22%
Fallon Mcaid Carelon Hlth [29]	$1,253	22%
Cigna	$2,759 - $6,872	49%
Tufts [11201]	$2,759	49%
Hne [11108]	$3,685	65%
Wellpoint [11112]	$6,823	120%
Hsno/Free Care [10801]	$7,544	133%
Institution [10406]	$7,544	133%
Mgb Mcr [10124]	$7,544	133%
Blue Cross Blue Shield	$7,875	139%
Aetna	$7,921	140%
Commonwealth Care Alliance [10103]	$7,921	140%
Fallon Mcr Supp [20202]	$7,921	140%
Fallon Mcr [10105]	$7,921	140%
Tufts Mcr [10112]	$7,921	140%
UnitedHealthcare	$7,921 - $8,072	140%
Senior Whole Health [10110]	$8,072	142%
Tufts Connectorcare [10507]	$10,509	185%
Fallon Connectorcare [10503]	$10,820	191%

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 $17,834.
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 UMass Memorial Health - Harrington Hospital 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.