CMS Price Transparency Data

Inguinal hernia repair

Facility: M Health Fairview St John's Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,594
Cash Discount Price: $669
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at M Health Fairview St John's Hospital is $1,594. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $669. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.44x the Medicare baseline. Located in 1575 Beam Avenue, Maplewood, MN.

Cash / Self-Pay

$669

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,594

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: $669 (18%)

Insurance Median: $1,594 (44%)

Cash: $669 (18% of Medicare)

Ins. Median: $1,594 (44% 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
Sanford Health Plan	$63 - $3,433	2%
Security Health Plan	$78 - $3,433	2%
America'S Ppo	$81 - $1,601	2%
First Health	$87 - $1,662	2%
Multiplan	$90 - $1,723	2%
Private Healthcare Systems	$90 - $1,723	2%
Wisconsin Physician Services	$96 - $1,824	3%
Health Partners	$345 - $7,942	9%
Primewest	$345 - $3,433	9%
South Country Health Alliance	$345 - $3,433	9%
Ucare	$352 - $7,889	10%
Medica	$367 - $4,192	10%
Blue Cross Blue Shield	$393 - $6,349	11%
Itasca Medical Care	$393 - $3,433	11%
UnitedHealthcare	$468 - $5,499	13%
Wellcare	$468 - $3,433	13%
Hennepin Health	$529 - $3,554	14%

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 $669.
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 M Health Fairview St John's 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.