CMS Price Transparency Data

Inguinal hernia repair

Facility: Adventist Health St Helena

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $691
Cash Discount Price: $294
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Adventist Health St Helena is $691. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $294. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.19x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$294

Average discount available for prompt cash payment at this facility.

Insurance Median

$691

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: $294 (8%)

Insurance Median: $691 (19%)

Cash: $294 (8% of Medicare)

Ins. Median: $691 (19% 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
Phcs-All Plans	$146 - $1,616	4%
Health Management Network-All Plans	$226 - $2,498	6%
Three Rivers-All Plans	$239 - $2,645	7%
Blue Shield Bh Mcr Adv	$548	15%
Blue Shield Mcr Adv	$548	15%
Kaiser Mcr Adv	$548	15%
Tricare	$548	15%
Ah Employee Health Plan - All Plans	$603	16%
Cigna	$634	17%
Interplan-All Plans	$658	18%
Kaiser-All Other Plans	$658	18%
UnitedHealthcare	$691	19%
Aetna	$726	20%
Blue Shield Epn-All Other Plans	$763	21%
Western Growers-All Plans	$784	21%
Blue Shield Non-Epn	$806	22%
Blue Cross Blue Shield	$1,039	28%

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 $294.
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 Adventist Health St Helena 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.