CMS Price Transparency Data

Inguinal hernia repair

Facility: Providence Santa Rosa Memorial Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $11,377
Cash Discount Price: $7,671
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Providence Santa Rosa Memorial Hospital is $11,377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,671. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 3.11x the Medicare baseline. Located in 1165 Montgomery Dr, Santa Rosa, CA.

Cash / Self-Pay

$7,671

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,377

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: $7,671 (210%)

Insurance Median: $11,377 (311%)

Cash: $7,671 (210% of Medicare)

Ins. Median: $11,377 (311% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 311% of the Medicare baseline (a markup of 211%). 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
Blue Shield	$4,233 - $5,159	116%
Healthnet	$4,982 - $16,652	136%
Aetna	$5,084 - $25,242	139%
Blue Cross Blue Shield	$9,773 - $14,021	267%
UnitedHealthcare	$11,377 - $12,866	311%

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 $7,671.
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 Providence Santa Rosa Memorial Hospital 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.