CMS Price Transparency Data

Inguinal hernia repair

Facility: Adventist Health Sonora

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $344
Cash Discount Price: $176
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Adventist Health Sonora is $344. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $176. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.09x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$176

Average discount available for prompt cash payment at this facility.

Insurance Median

$344

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: $176 (5%)

Insurance Median: $344 (9%)

Cash: $176 (5% of Medicare)

Ins. Median: $344 (9% 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
UnitedHealthcare	$209 - $2,303	6%
Beech Street- All Plans	$218 - $2,405	6%
Trpn - Three Rivers Ppo - All Plans	$218 - $2,405	6%
Bc Mcal	$242 - $344	7%
Celtic Ca Hlth Well Mcal - All Plans	$242 - $344	7%
Central Ca Alliance Ccs Mcal	$242 - $516	7%
Central Ca Alliance Chdp Mcal	$242 - $688	7%
Central Ca Alliance Comm Profee Only-All Other Pla	$242 - $516	7%
Central Ca Alliance Mcal	$242 - $344	7%
Healthnet Mcal	$242 - $344	7%
Medi-Cal	$242 - $344	7%
Blue Shield Mcare	$498	14%
Central Ca Alliance Mcr Adv Profee Only	$498	14%
Healthnet Mcr Adv	$498	14%
Tricare	$498	14%
Ah Employee Health Plan - All Plans	$548	15%
Cigna	$613	17%
Greatwest Oa/Pos/Hmo	$647	18%
Greatwest Ppo - All Other Plans	$647	18%
Western Growers/Pinnacle - All Plans	$692	19%
Blue Shield Epn	$706	19%
Healthnet - All Other Plans	$726	20%
Blue Shield - All Other Plans	$746	20%
Aetna	$809	22%
Bc Mcs	$886	24%
Bc Non-Mcs - All Other Plans	$886	24%

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 $176.
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 Adventist Health Sonora 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.