CMS Price Transparency Data
Inguinal hernia repair
Facility: Pennsylvania Hospital
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $5,318
- Cash Discount Price: $9,349
- vs. Medicare Baseline: 1.45x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Pennsylvania Hospital is $5,318. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,349. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.45x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$9,349
Average discount available for prompt cash payment at this facility.
Insurance Median
$5,318
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: $9,349 (256%)
Insurance Median: $5,318 (145%)
Cash: $9,349 (256% of Medicare)
Ins. Median: $5,318 (145% 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.
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 |
|---|---|---|
| Keystone Mercy Health Plan | $406 | 11% |
| Upmc | $540 - $9,349 | 15% |
| Medicaid / KanCare | $587 - $9,349 | 16% |
| Gateway Health Plan | $806 - $4,644 | 22% |
| Pa Medical Assistance | $806 | 22% |
| UnitedHealthcare | $1,447 - $9,349 | 40% |
| Horizon Nj Health | $1,580 - $1,644 | 43% |
| Pgm - Regie De L'Assurance Maladie Quebec | $2,150 | 59% |
| Preferred Health Care Eliance | $2,431 | 66% |
| Blue Cross Blue Shield | $2,524 - $35,453 | 69% |
| Health Partners | $2,809 - $9,349 | 77% |
| Cigna | $3,167 - $7,301 | 87% |
| Pgm - Kuwait Defense | $3,272 - $4,207 | 89% |
| Devon | $3,553 - $4,207 | 97% |
| Qualcare | $3,553 | 97% |
| Coventry | $3,740 - $4,768 | 102% |
| Pgm - Chop | $3,740 | 102% |
| Wissahickon Hospice | $3,740 | 102% |
| Medicare (plans) | $3,745 - $3,820 | 102% |
| Philadelphia Va Medical Center | $3,745 | 102% |
| Tricare | $3,763 | 103% |
| Ibc | $3,820 | 104% |
| Geisinger Health Plan | $3,857 - $11,877 | 105% |
| Humana | $3,857 - $7,479 | 105% |
| Pa Health And Wellness | $3,932 - $6,179 | 107% |
| Penn Life (Living Independently For Elders) | $3,932 | 107% |
| Aetna | $3,970 - $9,349 | 109% |
| Clover Health Plan | $4,044 | 111% |
| Keystone First | $4,157 | 114% |
| Healthamerica/Coventry | $4,207 - $4,581 | 115% |
| Us Family Health Plan | $4,328 | 118% |
| Olympus | $4,544 | 124% |
| First Health Global | $4,674 | 128% |
| Urn-Cancer Resource Services | $4,674 | 128% |
| Elap | $5,318 | 145% |
| Health Net | $5,609 | 153% |
| Pgm - Royal Embassy Of Saudi Arabia | $5,609 | 153% |
| Ibc Commercial Hpn | $5,902 | 161% |
| Claims Watcher | $5,992 - $6,741 | 164% |
| Pgm - Embassy Of Qatar | $6,077 | 166% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $6,077 | 166% |
| Oscar Health Plan | $6,366 | 174% |
| Pgm - Embassy Of The United Emirates/Ipc | $6,544 | 179% |
| Keystone Hmo Proactive | $6,722 | 184% |
| Centivo | $6,741 | 184% |
| Elap Services | $6,965 | 190% |
| Devon Health Services Inc | $7,479 | 204% |
| Health America/Ccn | $7,479 | 204% |
| Intergroup | $7,479 | 204% |
| Pgm - Kuwait Health Division | $7,479 | 204% |
| Pgm - Kuwait Oil | $7,479 | 204% |
| Preferred Care | $7,479 | 204% |
| Highmark | $7,875 | 215% |
| Commercial Other | $9,349 | 256% |
| Community Behavioral Health | $9,349 | 256% |
| International Pfs | $9,349 | 256% |
| Quest Behavioral Health | $9,349 | 256% |
| United Behavioral Health | $9,349 | 256% |
| Workers Compensation | $9,349 | 256% |
| Penn Global Medicine | $9,924 | 271% |