CMS Price Transparency Data

Inguinal hernia repair

Facility: Essentia Health St Mary's Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 49505
  • Insurance Median: $3,365
  • Cash Discount Price: $2,866
  • vs. Medicare Baseline: 0.92x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Essentia Health St Mary's Medical Center is $3,365. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,866. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.92x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.
Cash / Self-Pay
$2,866

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,365

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: $2,866 (78%)
Insurance Median: $3,365 (92%)
Cash: $2,866 (78% of Medicare)
Ins. Median: $3,365 (92% 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.

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
Medica Access $1,437 39%
Healthpartners Care Pmap $1,728 47%
Sanford Health Plan $1,862 - $6,249 51%
Blue Cross Blue Shield $1,917 - $7,980 52%
Blue Plus Pmap Pcc Prime $1,917 - $2,171 52%
Medica $2,401 - $2,466 66%
Medica Uplan $2,401 66%
Healthpartners $2,601 - $3,105 71%
Medica Choice $2,653 73%
Ucare $2,857 78%
Cigna $3,105 85%
Healthpartners Pcc Prime $3,105 85%
Wea $3,126 - $3,343 85%
UnitedHealthcare $3,178 - $3,539 87%
Primewest $3,336 91%
Security Health $3,343 91%
America'S Ppo $3,365 92%
Itasca Med Care $3,529 96%
Advocare/Security Health $3,539 97%
Freedom Blue Ppo $3,539 97%
Healthpartners Care Msho / Mcr Adv $3,539 97%
Imcare Msho (Ref Req) $3,539 97%
Imcare Msho Pcc Prime $3,539 97%
Imcare Msho Ref Req $3,539 97%
Medica Advantage Solutions $3,539 97%
Medica Msho/Dual Solutions $3,539 97%
Medica Prime Solution Group $3,539 97%
Medicare (plans) $3,539 97%
Nd Va Administration $3,539 97%
Platinum Blue / Vantage Blue $3,539 97%
Primewest Msho $3,539 97%
Secure Blue Msho $3,539 97%
Ubh Cost Plan $3,539 97%
Ubh Msho $3,539 97%
Ucare Msho $3,539 97%
Wps $3,604 - $3,647 99%
Aetna $3,691 101%
Healthscope Benefits $3,691 101%
Healtheos $3,734 102%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 402 East Second Street, Duluth, MN 55805
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals