CMS Price Transparency Data

Inguinal hernia repair

Facility: Monroe Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $4,146
Cash Discount Price: $3,769
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Monroe Hospital is $4,146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,769. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.13x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$3,769

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,146

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: $3,769 (103%)

Insurance Median: $4,146 (113%)

Cash: $3,769 (103% of Medicare)

Ins. Median: $4,146 (113% 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
Blue Cross Blue Shield	$2,274 - $6,785	62%
Care Source	$2,274 - $5,466	62%
Medicaid / KanCare	$2,274	62%
Monroe Medical Group And Managed Health Services	$2,274 - $5,089	62%
UnitedHealthcare	$2,274 - $3,770	62%
Aetna	$3,770	103%
Medicare (plans)	$3,770	103%
Tricare	$3,770	103%
Usa Senior Care Network	$3,770	103%
Worthington Christian Fellowship	$3,770	103%
Provider Partners Health Plan	$4,146	113%
Employer Direct Healthcare	$5,277	144%
Corvel Workers Compensation	$6,559	179%
Zelis Healthcare Fka Stratose	$7,162	196%
Americas Choice Provider Network Acpn	$7,313	200%
Multiplan	$7,313	200%
Prime Health Services	$7,313	200%
Three Rivers	$7,313	200%
Encore Health Network Workers Compensation	$7,388	202%
Provider Select	$7,464	204%
Provider Network Of America	$7,539	206%
Workers Compensation	$7,539	206%

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 $3,769.
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 Monroe 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.