CMS Price Transparency Data

Inguinal hernia repair

Facility: Berkeley Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,506
Cash Discount Price: $9,052
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Berkeley Medical Center is $5,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,052. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.51x the Medicare baseline. Located in 2500 Hospital Drive, Martinsburg, WV.

Cash / Self-Pay

$9,052

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,506

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: $9,052 (247%)

Insurance Median: $5,506 (151%)

Cash: $9,052 (247% of Medicare)

Ins. Median: $5,506 (151% 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
Medicare (plans)	$3,446 - $6,193	94%
Aetna	$3,618 - $6,135	99%
Humana	$3,618 - $6,135	99%
UnitedHealthcare	$3,756 - $6,369	103%
Caresource Exchange Plan	$5,169 - $8,764	141%

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 $9,052.
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 Berkeley Medical Center 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.