CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $209
Cash Discount Price: $265
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at UMass Memorial Health - Harrington Hospital is $209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.78x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$265

Average discount available for prompt cash payment at this facility.

Insurance Median

$209

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: $265 (225%)

Insurance Median: $209 (178%)

Cash: $265 (225% of Medicare)

Ins. Median: $209 (178% 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
Champva [11001]	$80 - $153	68%
Cigna	$80 - $248	68%
Institution [10406]	$80 - $162	68%
Mgb Mcr [10124]	$80 - $162	68%
Tufts Us Family [11203]	$80 - $162	68%
Blue Cross Blue Shield	$83 - $167	71%
Aetna	$84 - $349	71%
Commonwealth Care Alliance [10103]	$84 - $170	71%
Fallon Mcr Supp [20202]	$84 - $170	71%
Fallon Mcr [10105]	$84 - $170	71%
Tufts Mcr [10112]	$84 - $170	71%
UnitedHealthcare	$84 - $349	71%
Senior Whole Health [10110]	$86 - $173	73%
Workers Compensation [20501]	$100	85%
Medicaid / KanCare	$136 - $181	116%
Tufts Connectorcare [10507]	$137 - $275	117%
Tufts [11201]	$186 - $248	158%
First Health Network [11120]	$196 - $262	167%
Evernorth Behavioral Health [27]	$209 - $279	178%
Connecticare [11105]	$261 - $349	222%
Fallon Carelon Hlth [28]	$261 - $349	222%
Fallon Mcaid Carelon Hlth [29]	$261 - $349	222%
Grants [20507]	$261 - $349	222%
Masshealth Mcd Mbhp [38]	$261 - $349	222%
Wellsense Mcaid Carelon Hlth [21]	$261 - $349	222%
Hsno/Free Care [10801]	$681	579%

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 $265.
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 Health - Harrington Hospital 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.