CMS Price Transparency Data

Inguinal hernia repair

Facility: Providence St Mary Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $8,652
Cash Discount Price: $2,153
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Providence St Mary Medical Center is $8,652. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,153. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.37x the Medicare baseline. Located in 18300 Highway 18, Apple Valley, CA.

Cash / Self-Pay

$2,153

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,652

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: $2,153 (59%)

Insurance Median: $8,652 (237%)

Cash: $2,153 (59% of Medicare)

Ins. Median: $8,652 (237% 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 237% of the Medicare baseline (a markup of 137%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$4,605 - $11,564	126%
Heritage Provider Network	$4,881 - $5,480	133%
UnitedHealthcare	$7,824 - $8,644	214%
Blue Shield	$8,024 - $10,378	219%
Healthnet	$8,660	237%
Kaiser	$11,678	319%
Blue Cross Blue Shield	$16,413 - $19,696	449%

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 $2,153.
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 Providence St Mary Medical Center 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.