CMS Price Transparency Data

Inguinal hernia repair

Facility: Riverview Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $7,260
Cash Discount Price: $3,906
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Riverview Medical Center is $7,260. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,906. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.98x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$3,906

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,260

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: $3,906 (107%)

Insurance Median: $7,260 (198%)

Cash: $3,906 (107% of Medicare)

Ins. Median: $7,260 (198% 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
Karna	$1,091	30%
UnitedHealthcare	$1,189 - $14,048	33%
Aetna	$1,365 - $8,419	37%
Clover	$1,742	48%
Horizon	$1,892 - $10,715	52%
Seoul Medical Group	$2,101	57%
Blue Cross Blue Shield	$2,110 - $3,906	58%
Wellcare	$3,906	107%
Vaccn	$3,906	107%
United Community/Americhoice	$4,101	112%
Cigna	$4,418 - $7,744	121%
Qualcare	$6,256 - $8,518	171%
Bergen Risk	$7,260	198%
Multiplan - PHCS	$8,228	225%
Activecare First McO	$8,228	225%
Amerihealth	$8,371 - $9,482	229%
Brighton Health Plan	$9,933	272%
Oxford	$11,277	308%

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 $3,906.
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 Riverview Medical Center 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.