CMS Price Transparency Data

Inguinal hernia repair

Facility: Prov Sacred Hrt Med Ctr & Childs Hosp.

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $7,281
Cash Discount Price: $8,385
vs. Medicare Baseline: 1.99x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Prov Sacred Hrt Med Ctr & Childs Hosp. is $7,281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,385. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.99x the Medicare baseline. Located in 101 West 8Th Avenue, Spokane, WA.

Cash / Self-Pay

$8,385

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,281

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: $8,385 (229%)

Insurance Median: $7,281 (199%)

Cash: $8,385 (229% of Medicare)

Ins. Median: $7,281 (199% 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
Kaiser	$3,990 - $10,058	109%
Aetna	$4,109 - $20,964	112%
UnitedHealthcare	$4,189 - $13,236	115%
Blue Shield	$4,309	118%
Community Health Plan	$4,389	120%
Cigna	$4,788 - $11,397	131%
Molina	$6,743	184%
Blue Cross Blue Shield	$6,949 - $8,980	190%
Coordinated Care	$7,381	202%
First Choice	$9,639	264%
Providence Health Plan	$10,154	278%

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 $8,385.
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 Prov Sacred Hrt Med Ctr & Childs Hosp. 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.