CMS Price Transparency Data

Inguinal hernia repair

Facility: Jefferson Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $528
Cash Discount Price: $281
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Jefferson Hospital is $528. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $281. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.14x the Medicare baseline. Located in 565 Coal Valley Road, Jefferson Hills, PA.

Cash / Self-Pay

$281

Average discount available for prompt cash payment at this facility.

Insurance Median

$528

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: $281 (8%)

Insurance Median: $528 (14%)

Cash: $281 (8% of Medicare)

Ins. Median: $528 (14% 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
Univera	$53 - $623	1%
Amerihealth	$67 - $3,565	2%
University Of Pittsburgh Medical Center	$73 - $3,395	2%
Aetna	$76 - $8,270	2%
Pennsylvania Health And Wellness	$84 - $1,209	2%
Highmark Wholecare	$88 - $3,599	2%
Geisinger	$92 - $1,290	3%
UnitedHealthcare	$92 - $11,121	3%
Highmark	$564 - $5,576	15%
Cigna	$837 - $8,351	23%
American Health Plans	$3,395	93%
Life Pittsburgh	$3,395	93%
Martin'S Point	$3,395	93%
Medicare (plans)	$3,497	96%
Humana	$3,599	98%
Molina	$3,701	101%
Medical Mutual	$8,351	228%

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 $281.
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 Jefferson Hospital 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.