CMS Price Transparency Data

Inguinal hernia repair

Facility: UPMC Somerset

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,251
Cash Discount Price: $1,697
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at UPMC Somerset is $3,251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,697. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.89x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$1,697

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,251

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: $1,697 (46%)

Insurance Median: $3,251 (89%)

Cash: $1,697 (46% of Medicare)

Ins. Median: $3,251 (89% 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
Upmc Health Plan	$349 - $4,228	10%
Amerihealth Caritas	$364 - $3,365	10%
Highmark Wholecare (Prev Gateway)	$407 - $3,633	11%
Geisinger	$441	12%
UnitedHealthcare	$927 - $3,365	25%
Blue Cross Blue Shield	$1,021 - $6,316	28%
Upmc Work Partners	$1,060	29%

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 $1,697.
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 UPMC Somerset 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.