CMS Price Transparency Data
Inguinal hernia repair
Facility: Hospital of Univ of Pennsylvania
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $6,334
- Cash Discount Price: $13,591
- vs. Medicare Baseline: 1.73x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Hospital of Univ of Pennsylvania is $6,334. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,591. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.73x the Medicare baseline. Located in 3400 Spruce St, Philadelphia, PA.
Cash / Self-Pay
$13,591
Average discount available for prompt cash payment at this facility.
Insurance Median
$6,334
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: $13,591 (372%)
Insurance Median: $6,334 (173%)
Cash: $13,591 (372% of Medicare)
Ins. Median: $6,334 (173% 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.
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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 | $540 - $13,591 | 15% |
| Medicaid / KanCare | $587 - $13,591 | 16% |
| Pa Medical Assistance | $806 - $13,591 | 22% |
| Kaiser Permanente | $846 - $13,591 | 23% |
| Keystone Mercy Health Plan | $1,032 - $13,591 | 28% |
| Paired Kidney Exchange | $1,359 | 37% |
| UnitedHealthcare | $1,588 - $13,591 | 43% |
| Gspp And Wissahickon Hospice | $1,882 | 51% |
| Horizon Nj Health | $2,297 - $2,389 | 63% |
| Health Partners | $2,822 - $13,591 | 77% |
| Preferred Health Care Eliance | $2,990 | 82% |
| Pgm - Regie De L'Assurance Maladie Quebec | $3,126 | 85% |
| Blue Cross Blue Shield | $3,670 - $35,453 | 100% |
| Medicare (plans) | $3,763 - $3,839 | 103% |
| Philadelphia Va Medical Center | $3,763 | 103% |
| Tricare | $3,763 | 103% |
| Ibc | $3,839 | 105% |
| Cigna | $3,876 - $7,301 | 106% |
| Geisinger Health Plan | $3,876 - $11,935 | 106% |
| Humana | $3,876 - $10,873 | 106% |
| Devoted Health | $3,951 | 108% |
| Pa Health And Wellness | $3,951 - $6,209 | 108% |
| Penn Life (Living Independently For Elders) | $3,951 | 108% |
| Aetna | $3,989 - $13,591 | 109% |
| Clover Health Plan | $4,064 | 111% |
| Keystone First | $4,177 | 114% |
| Us Family Health Plan | $4,328 | 118% |
| Gateway Health Plan | $4,666 | 128% |
| Pgm - Kuwait Defense | $4,757 - $6,116 | 130% |
| Qualcare | $5,165 | 141% |
| Olympus | $5,341 | 146% |
| Elap | $5,344 | 146% |
| Coventry | $5,436 - $6,931 | 149% |
| Pgm - Chop | $5,436 | 149% |
| Wissahickon Hospice | $5,436 | 149% |
| Ibc Commercial Hpn | $5,902 | 161% |
| Claims Watcher | $6,021 - $6,774 | 165% |
| Healthamerica/Coventry | $6,116 - $6,660 | 167% |
| Oscar Health Plan | $6,398 | 175% |
| Keystone Hmo Proactive | $6,722 | 184% |
| Centivo | $6,774 | 185% |
| First Health Global | $6,796 | 186% |
| Elap Services | $7,000 | 191% |
| Highmark | $7,914 | 216% |
| Health Net | $8,155 | 223% |
| Pgm - Royal Embassy Of Saudi Arabia | $8,155 | 223% |
| Pgm - Embassy Of Qatar | $8,834 | 242% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $8,834 | 242% |
| Interlink | $9,106 | 249% |
| Pgm - Embassy Of The United Emirates/Ipc | $9,514 | 260% |
| Penn Global Medicine | $9,973 | 273% |
| Health America/Ccn | $10,873 | 297% |
| Intergroup | $10,873 | 297% |
| Pgm - Kuwait Health Division | $10,873 | 297% |
| Pgm - Kuwait Oil | $10,873 | 297% |
| Preferred Care | $10,873 | 297% |
| Blue Quality Centers For Transplant (Bqct) | $13,591 | 372% |
| City Of Philadelphia Behavioral Health | $13,591 | 372% |
| Commercial Other | $13,591 | 372% |
| International Pfs | $13,591 | 372% |
| United Behavioral Health | $13,591 | 372% |
| Workers Compensation | $13,591 | 372% |