CMS Price Transparency Data

Inguinal hernia repair

Facility: Stanford Health Care

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $650
Cash Discount Price: $1,143
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Stanford Health Care is $650. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,143. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.18x the Medicare baseline. Located in 300 Pasteur Drive, Stanford, CA.

Cash / Self-Pay

$1,143

Average discount available for prompt cash payment at this facility.

Insurance Median

$650

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: $1,143 (31%)

Insurance Median: $650 (18%)

Cash: $1,143 (31% of Medicare)

Ins. Median: $650 (18% 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
Health Plan Of San Mateo [31200]	$60 - $452	2%
Cigna	$69 - $758	2%
Beech St [10600]	$104 - $975	3%
Claritev [13400]	$104 - $975	3%
Kaiser Northern Ca [12900]	$104 - $975	3%
Private Healthcare Systems (Phcs) [14200]	$104 - $975	3%
Blue Card (Out Of State) [40000]	$120 - $1,126	3%
Blue Cross Blue Shield	$120 - $21,946	3%
Shca Comm Intel [20300000]	$120 - $1,126	3%
Healthnet Alt Payer [912100000]	$158 - $949	4%
Healthnet [12100]	$158 - $949	4%
UnitedHealthcare	$163 - $28,573	4%
Aetna	$172 - $34,690	5%
American Specialty Health Plan Alt Payer [971000000]	$174 - $1,088	5%
Blue Card (Out Of State) - Blue Shield [40200]	$174 - $1,088	5%
Blue Shield Alt Payer [970000000]	$174 - $1,088	5%
Blue Shield [70000]	$174 - $1,088	5%
Psych Blue Shield Alt Payer [970000100]	$174 - $1,088	5%
Healthnet	$5,266	144%
Blue Shield	$41,400	1132%

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 $1,143.
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 Stanford Health Care 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.