CMS Price Transparency Data

Inguinal hernia repair

Facility: Charlevoix Area Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $540
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Charlevoix Area Hospital is $540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.15x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$540

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%)

Insurance Median: $540 (15%)

Ins. Median: $540 (15% 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	$155 - $2,527	4%
Mclaren Health Plan	$340 - $2,527	9%
Meridian	$340 - $2,527	9%
Priority Health	$340 - $2,527	9%
UnitedHealthcare	$340 - $2,527	9%
Aetna	$501	14%
Blue Care Network	$501	14%
Hap (Health Alliance Plan)	$501 - $5,376	14%
Medicare (plans)	$501	14%
Michigan Amish Medical Board	$501	14%
Molina	$501	14%
Northern Michigan Mennonite Group	$501	14%
Asr Physicians Care Network	$751	21%
Nomi Health	$801	22%
Employee Benefits Logistics	$851	23%
Cigna	$967	26%
Provider Network Of America/Hma Group Health	$5,018	137%

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 $X.
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 Charlevoix Area 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.