CMS Price Transparency Data

Inguinal hernia repair

Facility: Mount Carmel St Ann's

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,933
Cash Discount Price: $21,607
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Mount Carmel St Ann's is $5,933. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,607. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.62x the Medicare baseline. Located in 500 South Cleveland Avenue, Westerville, OH.

Cash / Self-Pay

$21,607

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,933

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: $21,607 (591%)

Insurance Median: $5,933 (162%)

Cash: $21,607 (591% of Medicare)

Ins. Median: $5,933 (162% 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
Crime Victim Assistance	$632	17%
Ohio Safe Program	$632	17%
Medicare (plans)	$3,035 - $3,625	83%
Aetna	$3,383 - $8,144	92%
Blue Cross Blue Shield	$3,383 - $12,878	92%
UnitedHealthcare	$3,451 - $9,245	94%
Hospice Mount Carmel	$3,452	94%
The Health Plan	$3,521	96%
Oscar	$5,696	156%
American Postal Workers Secondary	$5,933	162%
Cigna	$5,933	162%
Health Partners	$5,933	162%
Healthgram	$5,933	162%
Mvp	$5,933	162%
Priority Health	$5,933	162%
Enterprise Group Planning	$6,663	182%
Custom Design Benefits	$7,215	197%
Quality Care Partners	$7,802	213%
Rural Carrier Health Benefit Plan	$8,144	223%
Medical Mutual	$8,484 - $12,283	232%
Geha	$9,245	253%
Western & Southern Financial Group	$12,283	336%
Blue Benefit Administrators Of Massachusetts	$12,878	352%
Blue Care Network	$12,878	352%
Blue Distinction Transplant	$12,878	352%
Blue Shield - Ca	$12,878	352%
Blue Shield - Id (Regence)	$12,878	352%
Blue Shield - Ny Highmark Northeastern	$12,878	352%
Blue Shield - Ny Highmark Western	$12,878	352%
Blue Shield - Pa (Highmark)	$12,878	352%
Blue Shield - Wa (Regence)	$12,878	352%

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 $21,607.
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 Mount Carmel St Ann's 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.