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District of Columbia

Cost of a Hernia Repair Visit
in District of Columbia

Reviewed by Momentary Medical Group West PC

The District of Columbia maintains the highest density of specialists per capita in the nation, creating both exceptional access and premium pricing for specialized procedures. Hernia Repair patients in DC typically pay between $381 and $1,221 for outpatient visits, with a median out-of-pocket cost of $901. With over 308 active Hernia Repair providers across the region, patients can browse all qualified specialists throughout the District of Columbia area.

Average

$834

Median

$901

Lowest

$381

Highest

$1,221

Providers

308

National avg: $843District of Columbia: $834

1% below national average

Compare Similar Procedures

How does inguinal hernia repair compare to related procedures in District of Columbia?

ProcedureCPTLowMedianHighProviders
Knee Replacement

Total knee replacement (arthroplasty)

27447$1,061$2,323$3,475309
Hip Replacement

Total hip replacement (arthroplasty)

27130$1,045$2,286$3,311318
Cataract Surgery

Cataract extraction with intraocular lens insertion

66984$414$887$1,311318
Knee Arthroscopy

Arthroscopy of the knee with meniscectomy

29881$443$927$1,591314
Gallbladder Removal (Laparoscopic)

Laparoscopic cholecystectomy

47562$511$1,109$1,618326
Appendectomy (Laparoscopic)

Laparoscopic appendectomy

44970$413$1,016$1,405334
Hysterectomy (Laparoscopic)

Laparoscopic total hysterectomy

58571$647$1,525$3,201348
Septoplasty

Nasal septum repair

30520$461$1,057$1,588311
Tonsillectomy

Tonsillectomy, primary or secondary

42820$220$479$681315
Mastectomy

Partial or simple mastectomy

19301$434$1,066$1,611317
Carpal Tunnel Surgery

Open carpal tunnel release

64721$328$739$1,686310

Important: These are cost estimates only — not a quote and not medical advice.

The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 49505Repair initial inguinal hernia, age 5 or older). They represent what a patient might pay without insurance.

Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.

This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.

Where this data comes from & what CPT 49505 covers

Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 49505 (Repair initial inguinal hernia, age 5 or older), as mandated by the CMS Price Transparency Rule.

What CPT 49505 covers: the provider's professional fee for inguinal hernia repair. It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.

How to read this data

Negotiated Rate

The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.

P5, Median, P95

P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.

What this does not tell you

These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.

Why Hernia Repair Visit Costs Vary Across District of Columbia

Healthcare costs in the District of Columbia run approximately 20% above the national average, driven by the region's high concentration of academic medical centers and premium real estate costs. The District's unique position as both a major metropolitan area and seat of federal government creates distinct cost pressures on medical services.

Urban vs. Rural Provider Availability

The District of Columbia's entirely urban geography concentrates all surgical specialists within a compact area, eliminating rural access issues but creating premium pricing due to high facility overhead costs. Patients benefit from exceptional provider density with over 308 hernia repair specialists serving the metro area. Competition among prestigious medical centers like George Washington, Georgetown, and Howard University hospitals maintains high service standards but also elevated pricing.

Facility Type and Overhead Costs

Hospital-based surgical clinics in the District command significantly higher fees than independent practices due to academic medical center overhead and teaching hospital status. Major health systems like MedStar and George Washington University Hospital integrate multiple specialties under expensive downtown real estate. Ambulatory surgery centers offer cost-effective alternatives but are less common in the District's space-constrained urban environment.

Insurance Market Competition in District of Columbia

CareFirst BlueCross BlueShield dominates the District's individual and employer markets, with UnitedHealthcare and Aetna providing additional competition primarily in the federal employee and Medicare Advantage segments. This concentrated market gives insurers significant negotiating power with providers, but also creates limited network options for patients. The federal employee presence drives demand for premium network access to prestigious medical centers.

Physician Supply and Demand in District of Columbia

With 308 active hernia repair providers serving a compact geographic area, the District enjoys excellent specialist availability relative to its population size. This robust supply reflects the region's role as a major medical training hub with multiple academic medical centers. However, high demand from affluent residents and federal employees, combined with premium facility costs, keeps pricing elevated despite adequate provider availability.

JP

Jayant Panwar

CEO, Momentary Labs · San Francisco, CA

Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.

The cost figures on this page reflect his ongoing work to make this data accessible to patients.

Healthcare Data AnalyticsCMS TiC DataInsurance Price Transparency

Frequently Asked Questions — Hernia Repair Costs in District of Columbia

What is the average cost of a Hernia Repair visit in District of Columbia without insurance?

Uninsured patients in DC typically pay between $381 and $1,221 for hernia repair consultations, with a median cost of $901. These prices reflect actual negotiated rates between insurers and providers, though self-pay patients may receive discounts of 20-40% from many practices. Independent surgical practices generally offer more affordable options than academic medical center-based clinics. Payment plans are commonly available to help manage these costs.

Does District of Columbia Medicaid cover Hernia Repair visits?

Yes, DC Medicaid provides comprehensive coverage for medically necessary hernia repair consultations and procedures since the District expanded Medicaid under the Affordable Care Act. Coverage typically requires documentation of symptoms and may need prior authorization for elective repairs. Most hernia specialists in the District accept DC Medicaid, though appointment availability may be more limited than with commercial insurance. Emergency hernia repairs are covered without prior authorization requirements.

How do I find an affordable Hernia Repair near me in District of Columbia?

Compare costs across independent surgical practices versus hospital-based clinics, as independent providers often charge 30-50% less for consultations. Ask about self-pay discounts if you're uninsured, and consider ambulatory surgery centers for procedures when appropriate. Community health centers in DC may offer sliding-scale fees for qualifying patients. Momentary Lab can instantly compare costs across hundreds of DC-area providers and check your specific insurance coverage.

What is the difference in cost between an initial consultation and a follow-up visit?

Initial hernia repair consultations typically cost between $381-$1,221 based on the complexity and time involved, while follow-up visits are generally 40-60% less expensive. New patient visits involve comprehensive evaluation, imaging review, and treatment planning, justifying the higher fees. Follow-up appointments focus on post-surgical care or monitoring of conservative management approaches. The specific cost difference depends on your insurance plan's copay structure and the provider's fee schedule.

Can I use an HSA or FSA to pay for a Hernia Repair visit in District of Columbia?

Yes, both HSA and FSA funds can be used for hernia repair consultations and procedures as they are considered qualified medical expenses under IRS guidelines. This includes diagnostic visits, imaging studies, and both surgical and non-surgical treatments recommended by your specialist. Keep all receipts and documentation for tax purposes. Using HSA/FSA funds effectively reduces your out-of-pocket costs by your marginal tax rate.

How does telemedicine affect the cost of seeing a Hernia Repair in District of Columbia?

Telemedicine consultations for hernia evaluation typically cost 20-40% less than in-person visits, though physical examination is usually necessary for definitive diagnosis and surgical planning. Many DC specialists offer virtual consultations for initial discussions, second opinions, or post-operative follow-up care. Insurance coverage for telehealth varies by plan, but most major insurers in the District now cover virtual specialist consultations. However, hands-on evaluation is essential for most hernia assessments.

Click a state to compare costs

Average Visit Cost

$337
$1,784

Office visit (CPT 49505)

Compare With Other States

RankStateAverage
1Wisconsin
Range: $73$4,031
$1,784
2Iowa
Range: $457$2,449
$1,346
3Alaska
Range: $440$2,338
$1,154
4Massachusetts
Range: $397$2,168
$1,133
5Montana
Range: $378$2,328
$1,120
6Georgia
Range: $421$1,969
$1,097
7South Dakota
Range: $439$2,034
$1,081
8Wyoming
Range: $628$1,642
$1,050
9New Hampshire
Range: $504$1,521
$1,002
10Nebraska
Range: $637$1,214
$994
11Washington
Range: $592$1,594
$984
12Minnesota
Range: $344$1,787
$970
13Rhode Island
Range: $440$1,521
$940
14North Dakota
Range: $437$1,537
$894
15Maine
Range: $630$1,022
$883
16Utah
Range: $374$1,150
$883
17California
Range: $423$1,216
$871
18Oregon
Range: $440$1,399
$866
19North Carolina
Range: $426$1,453
$859
20District of Columbia
Range: $381$1,221
$834
21Connecticut
Range: $368$1,435
$824
22New Mexico
Range: $465$1,226
$821
23West Virginia
Range: $381$1,378
$806
24Missouri
Range: $493$1,027
$804
25Colorado
Range: $441$1,242
$798
26Michigan
Range: $440$1,216
$797
27Delaware
Range: $330$1,435
$789
28Illinois
Range: $90$1,569
$789
29Pennsylvania
Range: $333$1,448
$781
30Idaho
Range: $438$1,197
$775
31Hawaii
Range: $426$1,149
$769
32New York
Range: $364$1,435
$768
33Kentucky
Range: $396$1,220
$763
34Vermont
Range: $391$1,271
$753
35Arkansas
Range: $461$1,043
$746
36New Jersey
Range: $309$1,435
$740
37Indiana
Range: $90$1,448
$722
38Mississippi
Range: $409$1,251
$718
39Tennessee
Range: $440$1,016
$705
40South Carolina
Range: $391$1,170
$705
41Texas
Range: $407$1,086
$699
42Alabama
Range: $356$1,111
$688
43Louisiana
Range: $383$1,052
$681
44Kansas
Range: $493$872
$667
45Virginia
Range: $358$1,079
$664
46Maryland
Range: $381$1,079
$653
47Oklahoma
Range: $429$991
$647
48Ohio
Range: $328$1,039
$638
49Nevada
Range: $423$859
$596
50Arizona
Range: $432$882
$585
51Florida
Range: $35$920
$337
Inguinal Hernia Repair in Other States