CMS Price Transparency Data

Inguinal hernia repair

Facility: Wheeling Hospital, Inc

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,619
Cash Discount Price: $8,520
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Wheeling Hospital, Inc is $3,619. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,520. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.99x the Medicare baseline. Located in 1 Medical Park, Wheeling, WV.

Cash / Self-Pay

$8,520

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,619

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: $8,520 (233%)

Insurance Median: $3,619 (99%)

Cash: $8,520 (233% of Medicare)

Ins. Median: $3,619 (99% 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
Geisinger Pennsylvania	$64	2%
Pennsylvania Health & Wellness	$64	2%
Highmark Health Options West Va	$206	6%
Wellpoint West Virginia	$206	6%
The Health Plan Wv	$209	6%
Aetna	$210 - $6,136	6%
Medicaid / KanCare	$2,240 - $3,798	61%
Blue Cross Blue Shield	$3,446 - $23,978	94%
Buckeye Commercial	$3,446 - $5,844	94%
Medicare (plans)	$3,446 - $6,194	94%
Humana	$3,619 - $6,136	99%
Senior Life Pa - Ma	$3,619 - $6,136	99%
UnitedHealthcare	$3,756 - $6,369	103%

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 $8,520.
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 Wheeling 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.