CMS Price Transparency Data

Inguinal hernia repair

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,129
Cash Discount Price: $6,717
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Cleveland Clinic Indian River Hospital is $1,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,717. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.31x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$6,717

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,129

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: $6,717 (184%)

Insurance Median: $1,129 (31%)

Cash: $6,717 (184% of Medicare)

Ins. Median: $1,129 (31% 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
UnitedHealthcare	$387	11%
Amerihealth	$407	11%
Medicaid / KanCare	$407	11%
Molina	$407	11%
Value Options	$407 - $565	11%
Wellcare	$407 - $3,542	11%
Blue Cross Blue Shield	$487 - $5,558	13%
Avmed	$565 - $8,112	15%
Careplus	$565 - $3,542	15%
Magellan	$565 - $10,681	15%
United	$565 - $8,320	15%
Freedom Health	$593 - $3,542	16%
Independent Living Systems	$593 - $3,720	16%
Wellmed	$593 - $3,542	16%
Clear Spring Health	$610 - $684	17%
Aetna	$635 - $14,242	17%
Cigna	$677 - $5,341	19%
Clarity Health	$1,863 - $11,571	51%
The Legacy Companies	$1,863 - $11,571	51%
National Provider Network	$2,006	55%
Three Rivers	$2,006	55%
Consociate Health	$2,150	59%
Carelon Bh Strategies	$3,542	97%
Humana	$3,542	97%
Devoted Health	$3,897	107%
Bmi	$9,791	268%
Multiplan	$14,242	389%

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 $6,717.
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 Cleveland Clinic Indian River Hospital 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.