CMS Price Transparency Data

Inguinal hernia repair

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,111
Cash Discount Price: $12,214
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Shriners Hospitals for Children Northern Calif is $5,111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,214. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.40x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$12,214

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,111

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: $12,214 (334%)

Insurance Median: $5,111 (140%)

Cash: $12,214 (334% of Medicare)

Ins. Median: $5,111 (140% 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
Cigna	$1,664	45%
Aetna	$1,924 - $4,647	53%
UnitedHealthcare	$2,155	59%
Blue Cross Blue Shield	$2,941 - $5,795	80%
Kaiser Permanente	$4,647	127%
Northbay Healthcare	$4,647	127%
Sutter Medical Foundation	$5,111	140%
Ambetter / Centene	$5,291 - $5,344	145%
Health Net Of Ca	$5,344	146%
Providence Health Plan	$6,120	167%
Sana Benefits	$6,505	178%

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 $12,214.
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 Shriners Hospitals for Children Northern Calif 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.