CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $271
Cash Discount Price: $449
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at UMass Memorial Health - Harrington Hospital is $271. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $449. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.85x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$449

Average discount available for prompt cash payment at this facility.

Insurance Median

$271

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $449 (472%)

Insurance Median: $271 (285%)

Cash: $449 (472% of Medicare)

Ins. Median: $271 (285% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 285% of the Medicare baseline (a markup of 185%). 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
Wellpoint [11112]	$42	44%
Champva [11001]	$65 - $153	68%
Workers Compensation [20501]	$66	69%
Harvard Pilgrim [10701]	$118	124%
Blue Cross Blue Shield	$124 - $167	130%
Cigna	$160 - $351	168%
Institution [10406]	$160 - $162	168%
Mgb Mcr [10124]	$160 - $162	168%
Tufts Us Family [11203]	$162	170%
Aetna	$168 - $494	176%
Commonwealth Care Alliance [10103]	$168 - $170	176%
Fallon Mcr Supp [20202]	$168 - $170	176%
Fallon Mcr [10105]	$168 - $170	176%
Tufts Mcr [10112]	$170	179%
UnitedHealthcare	$170 - $494	179%
Senior Whole Health [10110]	$173	182%
Medicaid / KanCare	$210 - $257	221%
Hne [11108]	$262	275%
Tufts Connectorcare [10507]	$271 - $275	285%
Tufts [11201]	$286 - $351	300%
First Health Network [11120]	$302 - $370	317%
Evernorth Behavioral Health [27]	$322 - $395	338%
Connecticare [11105]	$403 - $494	423%
Fallon Carelon Hlth [28]	$403 - $494	423%
Fallon Mcaid Carelon Hlth [29]	$403 - $494	423%
Grants [20507]	$403 - $494	423%
Masshealth Mcd Mbhp [38]	$403 - $494	423%
Wellsense Mcaid Carelon Hlth [21]	$403 - $494	423%
Hsno/Free Care [10801]	$681	715%

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 $449.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.