CMS Price Transparency Data
Inguinal hernia repair
Facility: Scripps Memorial Hospital - Encinitas
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $7,808
- Cash Discount Price: $3,621
- vs. Medicare Baseline: 2.13x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Scripps Memorial Hospital - Encinitas is $7,808. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,621. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.13x the Medicare baseline. Located in 354 Santa Fe Drive, Encinitas, CA.
Cash / Self-Pay
$3,621
Average discount available for prompt cash payment at this facility.
Insurance Median
$7,808
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: $3,621 (99%)
Insurance Median: $7,808 (213%)
Cash: $3,621 (99% of Medicare)
Ins. Median: $7,808 (213% 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 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $520 - $11,424 | 14% |
| UnitedHealthcare | $520 - $11,330 | 14% |
| Blue Cross Blue Shield | $1,066 - $11,890 | 29% |
| Cigna | $1,066 - $11,197 | 29% |
| Mc Alignment [917] | $1,066 - $2,346 | 29% |
| Mc Blue Shield Promise Health Plan [914] | $1,066 - $2,346 | 29% |
| Mc Blue Shield [902] | $1,066 - $2,346 | 29% |
| Mc Health Net [904] | $1,066 - $2,346 | 29% |
| Mc Scan [905] | $1,066 - $2,346 | 29% |
| Mc United [906] | $1,066 - $2,346 | 29% |
| Radys Cpmg [803] | $1,066 - $1,251 | 29% |
| Sharp Comm Med Grp [812] | $2,627 - $11,424 | 72% |
| Sharp Rees Stealy Med Grp [811] | $2,627 - $11,424 | 72% |
| Ucsd [807] | $2,627 - $11,424 | 72% |
| Uh [819] | $2,658 - $11,330 | 73% |
| Bc [814] | $2,705 - $10,877 | 74% |
| Imperial County Phys Med Group [855] | $2,705 - $10,877 | 74% |
| Integrated Health Partners [894] | $2,705 - $10,877 | 74% |
| Perlman Med Group [899] | $2,705 - $10,877 | 74% |
| Blue Shield [230] | $2,721 - $10,810 | 74% |
| Health Net [340] | $2,783 - $19,520 | 76% |
| Hn [815] | $2,783 - $10,797 | 76% |
| Bs [816] | $2,815 - $10,810 | 77% |
| Centivo [581] | $2,815 - $11,330 | 77% |
| Palomar Health [892] | $3,159 - $11,424 | 86% |
| Veba Med Grp [813] | $3,159 - $11,424 | 86% |
| Astiva Mcr Adv [464] | $4,605 - $7,808 | 126% |
| Bc Mcr Adv [830] | $4,605 - $7,808 | 126% |
| Bs Mcr Adv [829] | $4,605 - $7,808 | 126% |
| Central Health Mcr Adv [441] | $4,605 - $7,808 | 126% |
| Clever Care Mcr Adv [465] | $4,605 - $7,808 | 126% |
| D-Snp Mcr Adv [889] | $4,605 - $7,808 | 126% |
| Dsnp/Csnp - Generic [458] | $4,605 - $7,808 | 126% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $4,605 - $7,808 | 126% |
| Family Health Centers Pace Medi-Cal [555] | $4,605 - $7,808 | 126% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $4,605 - $7,808 | 126% |
| Gpmg/Altura - Mcr Adv [888] | $4,605 - $7,808 | 126% |
| Hn Mcr Adv [832] | $4,605 - $7,808 | 126% |
| Humana | $4,605 - $7,808 | 126% |
| Integrated Health Partners - Mcr Adv [895] | $4,605 - $7,808 | 126% |
| Kaiser Northern Ca Region Mcr Adv [386] | $4,605 - $7,808 | 126% |
| La Care Mcr Adv Hmo [612] | $4,605 - $7,808 | 126% |
| Medicare (plans) | $4,605 - $7,808 | 126% |
| San Diego Pace Medi-Cal [553] | $4,605 - $7,808 | 126% |
| Scan Mcr Adv [835] | $4,605 - $7,808 | 126% |
| Scan [500] | $4,605 - $7,808 | 126% |
| Scan [818] | $4,605 - $7,808 | 126% |
| Sharp Comm Med Grp Mcr Adv [840] | $4,605 - $7,808 | 126% |
| Sharp Health Plan Mcr Adv [531] | $4,605 - $7,808 | 126% |
| Sharp Health Plan Mcr Adv [897] | $4,605 - $7,808 | 126% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $4,605 - $7,808 | 126% |
| St Paul'S Pace Medi-Cal [551] | $4,605 - $7,808 | 126% |
| Ucsd Mcr Adv [873] | $4,605 - $7,808 | 126% |
| Uh Mcr Adv [831] | $4,605 - $7,808 | 126% |
| Uh Palomar Health Mcr Adv [885] | $4,605 - $7,808 | 126% |
| Alignment Health Plan [443] | $4,743 - $8,042 | 130% |
| Rady Children'S Hospital [825] | $6,411 - $8,531 | 175% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $6,665 - $8,913 | 182% |
| Kaiser [380] | $6,665 - $8,913 | 182% |
| Kaiser [383] | $6,665 - $8,913 | 182% |
| Prime Healthcare [614] | $7,828 - $13,274 | 214% |
| Prospect Med Group [893] | $8,059 - $13,664 | 220% |
| Pnoa [615] | $9,997 - $11,728 | 273% |
| Choice Care Network [270] | $10,664 - $12,509 | 292% |
| Managed Health Network Mcr Adv [621] | $10,664 | 292% |
| Managed Health Network [620] | $10,664 | 292% |
| Managed Health Network [862] | $10,664 | 292% |
| Multi Plan Network [470] | $11,102 - $11,997 | 304% |
| First Health Network [330] | $11,728 - $11,997 | 321% |
| Healthsmart [350] | $11,997 - $12,509 | 328% |