Prp I/Hern Init Reduc >5 Yr: What It Costs and What's Fair

CPT 49505 · Medicare rate: $508 · National avg charge: $5,635 · BillKarma data from 95 providers

Reviewed 2026-04-05 · Pricing data year: 2026

Prp I/Hern Init Reduc >5 Yr (CPT 49505) is a surgical procedure typically performed in a hospital or accredited outpatient surgical center. It is usually recommended after more conservative treatments—such as medication or physical therapy—have not resolved the underlying problem. Recovery time ranges from a few days to several weeks depending on patient health and procedure complexity.

Cost by Billing Grade

Grade	Avg Hospital Charge	Medicare Rate	Est. Patient Cost*	Hospitals
C	$1,621	$508	$324	24
D	$1,315	$508	$263	3
F	$6,211	$508	$1,242	55
N/A	$11,602	$508	$2,320	13

*Estimated patient cost assumes 20% coinsurance after deductible is met. Actual cost depends on your specific plan, deductible status, and network.

Cost Range Across Hospitals

Min: $211 Max: $25,015

Grade A (≤2x Medicare) Grade B (2–3x) Grade C (3–5x) Grade D/F (5x+)

What This Procedure Typically Costs by Facility Type

Hospital

95 providers

$211 — $25,015 | Avg: $5,635 (11.1x Medicare)

Find Providers Near You for This Procedure

Grade A-B only

Showing 10 lowest-markup providers nationally across hospitals, surgery centers, and imaging centers. Enter ZIP code to compare local providers side by side.

Provider	Type	Location	Grade	Charge	Benchmark	Markup	Your Est. Cost
Eastern Maine Healthcare Systems Inland Hospital	Hospital	Waterville, ME	C	$211	$508 Medicare OPPS	0.4x	—
AdventHealth East Orlando	Hospital	Orlando, FL	D	$560	$508 Medicare OPPS	1.1x	—
ASCENSION CALUMET HOSPITAL	Hospital	CHILTON, WI	C	$1,515	$508 Medicare OPPS	3.0x	—
ASCENSION MEDICAL GROUP ST. VINCENT	Hospital	NORTH VERNON, IN	C	$1,574	$508 Medicare OPPS	3.1x	—
ADVENTHEALTH LAKE WALES	Hospital	LAKE WALES, FL	C	$1,693	$508 Medicare OPPS	3.3x	—
ADVENTIST HEALTH SYSTEM/SUNBELT, INC.	Hospital	TAMPA, FL	C	$1,693	$508 Medicare OPPS	3.3x	—
ADVENTHEALTH DADE CITY	Hospital	DADE CITY, FL	C	$1,693	$508 Medicare OPPS	3.3x	—
ADVENTHEALTH DURAND	Hospital	DURAND, WI	C	$1,693	$508 Medicare OPPS	3.3x	—
ADVENTHEALTH ZEPHYRHILLS	Hospital	ZEPHYRHILLS, FL	C	$1,693	$508 Medicare OPPS	3.3x	—
ADVENTIST HEALTH SYSTEM-SUNBELT INC	Hospital	APOPKA, FL	D	$1,693	$508 Medicare OPPS	3.3x	—

What Is a Fair Price for This Procedure?

Medicare pays $508 for Prp I/Hern Init Reduc >5 Yr (CPT 49505). This rate is set by CMS based on the actual cost of delivering the procedure, including physician time, overhead, and equipment. It's the most reliable national benchmark for what the procedure is worth.

A hospital charging $1,016 (2x Medicare) or less earns an A billing grade — these are the most fairly priced facilities for this procedure. The national average charge is $5,635 (11.1x Medicare).

If your bill shows more than $1,524 (3x Medicare) for this procedure, it may be worth reviewing the charges carefully. Upload your bill to check →

Frequently Asked Questions

How much does Prp I/Hern Init Reduc >5 Yr cost with insurance?

With insurance, your out-of-pocket cost for Prp I/Hern Init Reduc >5 Yr (CPT 49505) depends on your deductible, coinsurance rate, and in-network status. Medicare pays $508 for this procedure; the national average hospital charge is $5,635. Under standard 20% coinsurance after deductible, a patient at an average-charging hospital would owe approximately $1,127. Always verify your benefits before scheduling.

Does where I have Prp I/Hern Init Reduc >5 Yr done affect my recovery?

Hospital quality and surgical volume can influence outcomes for procedures like Prp I/Hern Init Reduc >5 Yr. High-volume centers tend to have lower complication rates for complex surgeries. However, billing grade is separate from quality ratings—some highly graded billing hospitals also have strong clinical outcomes. Review both the BillKarma billing grade and CMS quality stars when choosing a facility.

How do I negotiate the cost of Prp I/Hern Init Reduc >5 Yr if I'm on a high-deductible plan?

If you're paying a significant portion out-of-pocket, ask the hospital for their cash price before scheduling. Many hospitals offer 10–40% discounts for self-pay patients. Medicare pays $508 for this procedure—use that as your negotiating anchor. Also ask the billing department about payment plans or charity care if the cost poses a financial hardship.

Related Procedures

Colonoscopy · avg $3,682
Laparoscopy Appendectomy · avg $11,291
Colonoscopy W/Lesion Removal · avg $3,378

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