CMS Price Transparency Data

Inguinal hernia repair

Facility: UPMC Presbyterian Shadyside

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $7,096
Cash Discount Price: $8,450
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at UPMC Presbyterian Shadyside is $7,096. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,450. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.94x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$8,450

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,096

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: $8,450 (231%)

Insurance Median: $7,096 (194%)

Cash: $8,450 (231% of Medicare)

Ins. Median: $7,096 (194% 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 - $1,237	10%
Aetna	$413 - $3,701	11%
Highmark Wholecare (Prev Gateway)	$471 - $3,634	13%
Health Partners Plans (Jefferson Health Plan)	$479	13%
Geisinger	$494	14%
Amerihealth Caritas	$502 - $3,634	14%
Pa Health & Wellness	$541 - $3,634	15%
UnitedHealthcare	$967 - $3,634	26%
Blue Cross Blue Shield	$1,041 - $7,096	28%
Upmc Work Partners	$1,160	32%
Multiplan	$1,348 - $11,267	37%
Cigna	$3,634	99%
Preferred Healthcare System	$9,155	250%
Coventry/First Health	$9,859	270%
Fidelis	$10,563	289%
Intergroup	$10,563 - $11,971	289%
Health Coalition Partners	$11,267	308%
Private Health Care Systems	$11,267	308%
Selectcare	$11,267	308%
Health Payors Organization	$11,971	327%
Humana	$11,971	327%

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 $8,450.
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 Presbyterian Shadyside 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.