CMS Price Transparency Data

Group therapy session

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 90853 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90853
Insurance Median: $510
Cash Discount Price: $656
vs. Medicare Baseline: 4.91x Medicare

The contracted insurance negotiated median rate for a Group therapy session at UMass Memorial Health - Harrington Hospital is $510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $656. Compared to the federal Medicare reimbursement reference rate of $103.79, this hospital’s rate is 4.91x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$656

Average discount available for prompt cash payment at this facility.

Insurance Median

$510

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$103.79

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $103.79 (100%)

Cash / Self-Pay: $656 (632%)

Insurance Median: $510 (491%)

Cash: $656 (632% of Medicare)

Ins. Median: $510 (491% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $103.79 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 491% of the Medicare baseline (a markup of 391%). 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
Workers Compensation [20501]	$25	24%
Champva [11001]	$110	106%
Blue Cross Blue Shield	$128 - $138	123%
Mgb Mcr [10124]	$197	190%
Aetna	$208 - $656	200%
Senior Whole Health [10110]	$262	252%
Tufts Mcr [10112]	$262	252%
Tufts Connectorcare [10507]	$310	299%
Medicaid / KanCare	$341	329%
Hne [11108]	$427	411%
Cigna	$466 - $510	449%
Tufts [11201]	$466	449%
Fallon Connectorcare [10503]	$472	455%
Wellpoint [11112]	$483	465%
First Health Network [11120]	$492	474%
Evernorth Behavioral Health [27]	$525	506%
Harvard Pilgrim [10701]	$538	518%
UnitedHealthcare	$557 - $656	537%
Connecticare [11105]	$656	632%
Fallon Carelon Hlth [28]	$656	632%
Fallon Mcaid Carelon Hlth [29]	$656	632%
Grants [20507]	$656	632%
Masshealth Mcd Mbhp [38]	$656	632%
Wellsense Mcaid Carelon Hlth [21]	$656	632%
Hsno/Free Care [10801]	$681	656%

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 $656.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90853.

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 CPT code 90853.
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.