CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $146
Cash Discount Price: $200
vs. Medicare Baseline: 4.16x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UMass Memorial Health - Harrington Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.16x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$200

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $200 (570%)

Insurance Median: $146 (416%)

Cash: $200 (570% of Medicare)

Ins. Median: $146 (416% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 416% of the Medicare baseline (a markup of 316%). 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	71%
Cigna	$29 - $142	83%
Champva [11001]	$31	88%
Institution [10406]	$36	103%
Mgb Mcr [10124]	$36	103%
Tufts Us Family [11203]	$36	103%
Aetna	$38 - $200	108%
Fallon Mcr Supp [20202]	$38	108%
Fallon Mcr [10105]	$38	108%
Tufts Mcr [10112]	$38	108%
UnitedHealthcare	$38 - $200	108%
Blue Cross Blue Shield	$39 - $243	111%
Commonwealth Care Alliance [10103]	$40	114%
Senior Whole Health [10110]	$41	117%
Tufts Connectorcare [10507]	$65	185%
Wellpoint [11112]	$76	217%
Medicaid / KanCare	$104	297%
Hne [11108]	$130	371%
Tufts [11201]	$142	405%
First Health Network [11120]	$150	428%
Evernorth Behavioral Health [27]	$160	456%
Connecticare [11105]	$200	570%
Fallon Carelon Hlth [28]	$200	570%
Fallon Mcaid Carelon Hlth [29]	$200	570%
Grants [20507]	$200	570%
Masshealth Mcd Mbhp [38]	$200	570%
Wellsense Mcaid Carelon Hlth [21]	$200	570%
Fallon Connectorcare [10503]	$202	576%
Harvard Pilgrim [10701]	$202 - $242	576%
Hsno/Free Care [10801]	$681	1942%

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 $200.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.