CMS Price Transparency Data

Inguinal hernia repair

Facility: Penn State Health St. Joseph

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $4,151
Cash Discount Price: $5,966
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Penn State Health St. Joseph is $4,151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,966. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.13x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$5,966

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,151

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: $5,966 (163%)

Insurance Median: $4,151 (113%)

Cash: $5,966 (163% of Medicare)

Ins. Median: $4,151 (113% 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
[Amerihealth Caritas]	$3,095 - $3,641	85%
[Highmark Wholecare]	$3,095 - $3,641	85%
[Geisinger]	$3,277 - $16,548	90%
[Health Partners Plans]	$3,387 - $3,714	93%
[Pa Health & Wellness]	$3,405 - $3,751	93%
[Highmark]	$3,605 - $19,792	99%
UnitedHealthcare	$3,641 - $15,530	100%
[Cbc]	$3,641 - $12,126	100%
[Ibc]	$3,641 - $11,401	100%
Aetna	$3,678 - $11,716	101%
Humana	$3,678	101%
[Healthspring]	$3,678	101%
[Upmc]	$3,714 - $16,947	102%
[Point Comfort Underwriters]	$4,552	124%
Cigna	$14,073	385%
[Highmark Choice Blue]	$15,833	433%
[Highmark Aca]	$16,625	454%
[Preferred Healthcare Systems]	$17,204	470%
[First Health]	$18,351	502%
[Multiplan]	$18,351	502%

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 $5,966.
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 Penn State Health St. Joseph 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.