CMS Price Transparency Data

Inguinal hernia repair

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $2,755
Cash Discount Price: $1,615
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Nationwide Children's Hospital Toledo, LLC is $2,755. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,615. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.75x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$1,615

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,755

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: $1,615 (44%)

Insurance Median: $2,755 (75%)

Cash: $1,615 (44% of Medicare)

Ins. Median: $2,755 (75% 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
Mcclaren Health Plan - Michigan	$350 - $3,768	10%
Tricare	$475 - $3,353	13%
Caresource	$493 - $3,841	13%
Paramount	$493	13%
Blue Cross Blue Shield	$518 - $2,781	14%
Front Path Health Coalition	$641 - $10,974	18%
Mcclaren Health Plan	$690	19%
Aetna	$770	21%
UnitedHealthcare	$1,076 - $3,783	29%
Ohc	$2,018	55%
Ohio Ppo Connect	$2,018	55%
Mmo	$2,691	74%
Molina	$2,755 - $4,235	75%
Amerihealth	$2,781	76%
Bchp	$2,781	76%
Humana	$2,781	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 $1,615.
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 Nationwide Children's Hospital Toledo, LLC 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.