CMS Price Transparency Data

Inguinal hernia repair

Facility: Highland Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,091
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Highland Hospital is $5,091. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.39x the Medicare baseline. Located in 1411 East 31St Street, Oakland, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,091

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%)

Insurance Median: $5,091 (139%)

Ins. Median: $5,091 (139% 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
Kaiser Medi-Cal Managed Care [1026106]	$344	9%
Blue Cross Blue Shield	$817 - $8,632	22%
Alameda Alliance Commercial Alternate [4801]	$952	26%
Alameda Alliance Mgd Mcal Alternate [2801]	$952	26%
Alameda Alliance Non-Verified [1002303]	$952	26%
Alameda Alliance [1002106]	$952	26%
Alameda Alliance [1002206]	$952	26%
Mc Alameda Alliance Capitation [1002103]	$952	26%
Aetna	$1,538 - $8,632	42%
Brown Toland Medical Group Alternate [1049301]	$5,091 - $8,632	139%
Brown Toland Medical Group [1049001]	$5,091 - $8,632	139%
Brown Toland Mgd Mcr Alternate [1802]	$5,091 - $8,632	139%
Medicare (plans)	$5,091 - $8,632	139%
Health Net [1022001]	$14,000 - $23,738	383%

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 $X.
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 Highland 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.