CMS Price Transparency Data

Inguinal hernia repair

Facility: Cleveland Clinic

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,720
Cash Discount Price: $1,863
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Cleveland Clinic is $1,720. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,863. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.47x the Medicare baseline. Located in 9500 Euclid Avenue, Cleveland, OH.

Cash / Self-Pay

$1,863

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,720

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: $1,863 (51%)

Insurance Median: $1,720 (47%)

Cash: $1,863 (51% of Medicare)

Ins. Median: $1,720 (47% 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
UnitedHealthcare	$298 - $3,272	8%
Paramount	$323 - $2,620	9%
Summacare	$325 - $3,272	9%
Buckeye	$329 - $2,671	9%
Caresource	$329 - $2,544	9%
United	$336 - $7,778	9%
Amerihealth	$345	9%
Molina	$345 - $2,671	9%
Aetna	$500 - $3,272	14%
Blue Cross Blue Shield	$500 - $7,011	14%
Devoted Health	$500 - $3,272	14%
Humana	$500 - $3,272	14%
The Health Plan	$500 - $3,272	14%
Upmc	$500 - $3,272	14%
Valor	$500 - $3,272	14%
Cigna	$515 - $6,358	14%
Communicare	$526 - $3,435	14%
Perennial Health	$541 - $3,533	15%
Pphp	$541 - $3,599	15%
Zing Health	$551 - $3,599	15%
Oscar	$765	21%
Cc Ehp	$951	26%
Ohcp	$1,115	30%
Ohio Healthy	$1,146	31%
Aultcare	$1,232	34%
Amish Community Aid Plan	$1,290	35%
Omas	$1,433	39%
Mmo	$1,481 - $10,260	40%
Healthsmart	$1,576	43%
Phphi	$1,720	47%
Clarity Health	$1,863	51%
Gms	$2,006	55%
Quality Care Partners	$2,006	55%
Consociate Health	$2,150	59%
Multiplan	$2,579	71%
Three Rivers	$2,579	71%
Usa Managed Care	$2,579	71%
United Bh	$2,798	76%

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 $1,863.
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 Cleveland Clinic 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.