CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $169
Cash Discount Price: $208
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at UMass Memorial Health - Harrington Hospital is $169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $208. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.25x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$208

Average discount available for prompt cash payment at this facility.

Insurance Median

$169

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $208 (153%)

Insurance Median: $169 (125%)

Cash: $208 (153% of Medicare)

Ins. Median: $169 (125% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
Wellpoint [11112]	$58	43%
Medicaid / KanCare	$89 - $231	66%
Champva [11001]	$96 - $153	71%
Cigna	$96 - $345	71%
Institution [10406]	$96 - $162	71%
Mgb Mcr [10124]	$96 - $162	71%
Tufts Us Family [11203]	$96 - $162	71%
Blue Cross Blue Shield	$99 - $205	73%
Workers Compensation [20501]	$99	73%
Aetna	$100 - $444	74%
Commonwealth Care Alliance [10103]	$100 - $170	74%
Fallon Mcr Supp [20202]	$100 - $170	74%
Fallon Mcr [10105]	$100 - $170	74%
Tufts Mcr [10112]	$100 - $170	74%
UnitedHealthcare	$100 - $444	74%
Senior Whole Health [10110]	$102 - $173	75%
Tufts [11201]	$122 - $316	90%
First Health Network [11120]	$128 - $333	94%
Evernorth Behavioral Health [27]	$137 - $355	101%
Tufts Connectorcare [10507]	$162 - $275	119%
Harvard Pilgrim [10701]	$166	122%
Connecticare [11105]	$171 - $444	126%
Fallon Carelon Hlth [28]	$171 - $444	126%
Fallon Mcaid Carelon Hlth [29]	$171 - $444	126%
Grants [20507]	$171 - $444	126%
Masshealth Mcd Mbhp [38]	$171 - $444	126%
Wellsense Mcaid Carelon Hlth [21]	$171 - $444	126%
Hne [11108]	$289	213%
Hsno/Free Care [10801]	$681	502%

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 $208.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.