CMS Price Transparency Data

Inguinal hernia repair

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,514
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Independence Health System Butler Memorial Hospita is $3,514. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.96x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,514

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%)

Insurance Median: $3,514 (96%)

Ins. Median: $3,514 (96% 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
Medicaid / KanCare	$318	9%
UnitedHealthcare	$318 - $8,707	9%
Geisinger	$346 - $3,565	9%
Amerihealth	$349 - $3,565	10%
Jefferson Health Plan	$349	10%
Gateway	$359 - $3,811	10%
Upmc	$359 - $4,787	10%
Aetna	$365 - $7,809	10%
Pnoa	$1,102 - $3,735	30%
Ccbh - Behavioral Health	$2,394	65%
Workers Comp	$3,305	90%
Highmark	$3,327 - $7,161	91%
Life Butler County	$3,395	93%
Martin'S Point - Usfhp	$3,395	93%
Medicare (plans)	$3,395	93%
Peak Health	$3,395 - $7,978	93%
Provider Partners	$3,395	93%
Tricare	$3,395	93%
Humana	$3,531	97%
Devoted Health Plan	$3,599	98%
The Health Plan	$3,599 - $7,978	98%
Pa Health & Wellness	$3,633	99%
American Health Plan	$3,735	102%
Highmark Aca - Direct Blue	$4,475	122%
Ellwood Group	$6,790	186%
Highmark Community Blue	$7,021	192%
Cigna	$7,757	212%
Highmark - Ind.& Managed Care	$7,957	218%

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 $X.
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 Independence Health System Butler Memorial Hospita 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.