CMS Price Transparency Data

Inguinal hernia repair

Facility: Duke University Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $2,136
Cash Discount Price: $2,296
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Duke University Hospital is $2,136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,296. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.58x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$2,296

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,136

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: $2,296 (63%)

Insurance Median: $2,136 (58%)

Cash: $2,296 (63% of Medicare)

Ins. Median: $2,136 (58% 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
Aetna	$681 - $4,702	19%
Blue Cross Blue Shield	$706 - $4,294	19%
UnitedHealthcare	$706 - $7,346	19%
Humana	$723 - $7,227	20%
Alliance Health	$1,922 - $2,136	53%
Amerihealth	$1,922 - $2,136	53%
Carolina Complete Health	$1,922 - $2,136	53%
Trillium	$1,922 - $2,136	53%
Partners	$2,136	58%
Cigna	$3,137 - $8,502	86%
Troy Health	$3,437	94%
Voans	$3,437	94%
Liberty	$3,506	96%
Medcost	$3,622	99%
Sentara	$5,297	145%

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 $2,296.
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 Duke University 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.