CMS Price Transparency Data
Inguinal hernia repair
Facility: Physicians Care Surgical Hospital
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $10,004
- Cash Discount Price: $6,995
- vs. Medicare Baseline: 2.73x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Physicians Care Surgical Hospital is $10,004. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,995. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.73x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$6,995
Average discount available for prompt cash payment at this facility.
Insurance Median
$10,004
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: $6,995 (191%)
Insurance Median: $10,004 (273%)
Cash: $6,995 (191% of Medicare)
Ins. Median: $10,004 (273% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 273% of the Medicare baseline (a markup of 173%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Straight Access | $900 - $2,850 | 25% |
| Keystone First Vip Choice | $900 - $2,850 | 25% |
| PA Health and Wellness | $900 - $2,850 | 25% |
| Keystone First Healthplan | $900 - $2,850 | 25% |
| Keystone First | $900 - $2,850 | 25% |
| Medicaid / KanCare | $900 - $2,850 | 25% |
| Humana | $1,318 - $12,772 | 36% |
| Tricare | $1,318 - $12,772 | 36% |
| Connecticare | $3,242 - $19,575 | 89% |
| UPMC | $3,766 - $19,295 | 103% |
| Healthgram | $4,036 - $18,977 | 110% |
| Cigna | $4,036 - $18,977 | 110% |
| Loomis | $4,036 - $18,977 | 110% |
| Sana Benefits | $4,036 - $18,977 | 110% |
| Apwu | $4,036 - $18,977 | 110% |
| Freedom Life Insurance Company | $4,036 - $18,977 | 110% |
| Health Partners | $4,036 - $18,977 | 110% |
| Cwi Benefits | $4,036 - $18,977 | 110% |
| Nalc Health | $4,036 - $18,977 | 110% |
| Central PA Teamsters | $4,421 - $21,231 | 121% |
| Continental Benefits | $4,553 - $23,230 | 124% |
| Ag Administrators Inc | $4,553 - $23,230 | 124% |
| Lucent Health | $4,553 - $23,230 | 124% |
| Allied Benefit Systems | $4,553 - $23,230 | 124% |
| Ag Administrators | $4,553 - $23,230 | 124% |
| Healthez | $4,553 - $23,230 | 124% |
| Geha | $4,553 - $23,230 | 124% |
| Allied Benefits Systems | $4,553 - $23,230 | 124% |
| Marpai Health | $4,553 - $23,230 | 124% |
| Premier Care Network | $4,553 - $23,230 | 124% |
| Coventry | $4,553 - $23,230 | 124% |
| Trustmark | $4,553 - $23,230 | 124% |
| Meritain Health | $4,553 - $23,230 | 124% |
| Aetna | $4,553 - $23,230 | 124% |
| Aarp | $4,715 - $12,772 | 129% |
| Pcsh Aarp | $4,715 - $12,772 | 129% |
| Vibra Health Plan | $4,715 - $12,772 | 129% |
| Blue Cross Blue Shield | $4,715 - $23,941 | 129% |
| Medicare (plans) | $4,715 - $12,772 | 129% |
| Devon Health Services | $4,715 - $12,772 | 129% |
| Gpm Health and Life Insurance Mc Supplement | $4,715 - $12,772 | 129% |
| UnitedHealthcare | $4,715 - $27,099 | 129% |
| Personal Choice 65 | $4,715 - $12,363 | 129% |
| Ibc Security 65 | $4,715 - $12,363 | 129% |
| Keystone 65 HMO | $4,715 - $12,772 | 129% |
| Unified Health Services | $4,715 - $12,772 | 129% |
| Shenandoah Life | $4,715 - $12,772 | 129% |
| Ibc 2021 | $5,092 - $18,753 | 139% |
| Keystone Healthplan East | $5,092 - $18,753 | 139% |
| Ibc | $5,092 - $18,753 | 139% |
| Independence Bc | $5,092 - $18,753 | 139% |
| Amerihealth New Jersey HMO | $5,092 - $18,753 | 139% |
| Personal Choice | $5,092 - $18,753 | 139% |
| Keystone HMO | $5,092 - $18,753 | 139% |
| Amerihealth Administrators | $5,092 - $18,753 | 139% |
| Ibc Local | $5,092 - $18,753 | 139% |
| Horizon of New Jersey | $5,092 - $18,753 | 139% |
| Independence Administrators | $5,092 - $18,753 | 139% |
| Carefirst Administrators | $5,092 - $18,753 | 139% |
| Pcsh Ibc | $5,092 - $18,753 | 139% |
| Empire Plan | $5,092 - $18,753 | 139% |
| Keystone Direct POS | $5,092 - $18,753 | 139% |
| Independence Federal | $5,092 - $18,753 | 139% |
| Ibc - Local | $5,092 - $18,753 | 139% |
| Regence Blue Shield | $5,092 - $18,753 | 139% |
| Highmark | $6,102 - $23,941 | 167% |
| Oxford Health Plan | $10,004 - $27,099 | 273% |
| Allsavers | $10,004 - $27,099 | 273% |
| Golden Rule Op | $10,004 - $27,099 | 273% |
| Surest | $10,004 - $27,099 | 273% |
| Oxford Life Insurance Company | $10,004 - $27,099 | 273% |