CMS Price Transparency Data

Inguinal hernia repair

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,630
Cash Discount Price: $18,741
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at UMass Memorial Healthalliance Hospitals is $5,630. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,741. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.54x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$18,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,630

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,657.95

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,657.95 (100%)

Cash / Self-Pay: $18,741 (512%)

Insurance Median: $5,630 (154%)

Cash: $18,741 (512% of Medicare)

Ins. Median: $5,630 (154% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3,657.95 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
Hsno/Free Care [10801]	$294	8%
Fallon Connectorcare [10503]	$714 - $13,138	20%
Workers Compensation [20501]	$1,371	37%
Harvard Pilgrim [10701]	$2,653	73%
Blue Cross Blue Shield	$3,370 - $7,610	92%
Champva [11001]	$3,772 - $6,362	103%
UnitedHealthcare	$4,128 - $7,881	113%
Cigna	$4,344 - $7,366	119%
Correctional Care [11003]	$4,344 - $7,366	119%
Institution [10406]	$4,344 - $7,366	119%
Medicaid / KanCare	$4,344 - $7,366	119%
Medicare (plans)	$4,344 - $7,366	119%
Tufts Dual [10111]	$4,344 - $7,366	119%
Tufts Us Family [11203]	$4,344 - $7,366	119%
Aetna	$4,561 - $7,964	125%
Commonwealth Care Mcr [10115]	$4,561 - $7,734	125%
Fallon Mcr Supp [20202]	$4,561 - $7,734	125%
Harvard Pilgrim Mcr [10106]	$4,561 - $7,734	125%
Mgb Mcr [10124]	$4,561 - $7,734	125%
Tufts Mcr [10112]	$4,561 - $7,734	125%
Senior Whole Health [10110]	$4,648 - $7,881	127%
Tufts [11201]	$5,630	154%
Hne [11108]	$6,794	186%
Tufts Connectorcare [10507]	$7,389 - $12,529	202%
Wellpoint [11112]	$8,967	245%
First Health Network [11120]	$9,133	250%
Multiplan [11109]	$9,133	250%
Connecticare [11105]	$12,177	333%
Fallon Carelon Hlth [28]	$12,177	333%
Fallon Mcaid Carelon Hlth [29]	$12,177	333%
Grants [20507]	$12,177	333%

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 $18,741.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 49505.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Healthalliance Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 49505.
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.