CMS Price Transparency Data

Inguinal hernia repair

Facility: Prosser Memorial Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $589
Cash Discount Price: $855
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Prosser Memorial Hospital is $589. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $855. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.16x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$855

Average discount available for prompt cash payment at this facility.

Insurance Median

$589

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: $855 (23%)

Insurance Median: $589 (16%)

Cash: $855 (23% of Medicare)

Ins. Median: $589 (16% 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
Community Health Plan Of Washington	$297 - $589	8%
Coordinated Care	$297	8%
Kaiser Permanente	$297 - $1,086	8%
UnitedHealthcare	$297 - $589	8%
Molina	$312 - $589	9%
Amerigroup	$315	9%
Health Alliance Northwest	$589	16%
Humana	$589	16%
Wellcare	$589	16%
Cigna	$619	17%
Aetna	$695 - $716	19%
Premera	$709	19%
Asuris	$752	21%
Health Management Adminstrators	$752	21%
Regence	$752	21%
Ambetter / Centene	$1,061	29%
Multiplan	$1,321	36%

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 $855.
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 Prosser Memorial 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.