CMS Price Transparency Data

Inguinal hernia repair

Facility: Porter Hospital Inc

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $493
Cash Discount Price: $1,150
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Porter Hospital Inc is $493. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,150. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.13x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$1,150

Average discount available for prompt cash payment at this facility.

Insurance Median

$493

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: $1,150 (31%)

Insurance Median: $493 (13%)

Cash: $1,150 (31% of Medicare)

Ins. Median: $493 (13% 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
Wellpath	$126 - $632	3%
Coventry	$150 - $628	4%
Blue Cross Blue Shield	$178 - $7,636	5%
Medical Corporation	$218 - $1,092	6%
Multiplan	$218 - $1,092	6%
Veterans Affairs Community Care Network	$230 - $483	6%
UnitedHealthcare	$342 - $1,098	9%
Mvp	$411 - $956	11%
Fidelis Care	$435	12%
Humana	$459 - $3,353	13%
Aetna	$483	13%
Martins Point	$483	13%
Veterans Choice	$483	13%
Capital District Physicians' Health Plan	$488 - $795	13%
Harvard Pilgrim	$590	16%
Cigna	$843	23%

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 $1,150.
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 Porter Hospital Inc 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.