CMS Price Transparency Data

Inguinal hernia repair

Facility: Charleston Area Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $618
Cash Discount Price: $17,151
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Charleston Area Medical Center is $618. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,151. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.17x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$17,151

Average discount available for prompt cash payment at this facility.

Insurance Median

$618

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: $17,151 (469%)

Insurance Median: $618 (17%)

Cash: $17,151 (469% of Medicare)

Ins. Median: $618 (17% 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
Aetna	$406 - $525	11%
The Health Plan Of West Virginia Inc.	$406 - $821	11%
Unicare Health Plan Of West Virginia Inc.	$406	11%
Triwest Va	$498	14%
Blue Cross Blue Shield	$513 - $841	14%
Choicecare Network	$513 - $618	14%
Optimum Choice Inc.	$513	14%
UnitedHealthcare	$513 - $529	14%
West Virginia Senior Advantage Inc.	$539	15%
City Of Charleston	$667	18%
Naphcare	$703	19%
Integrated Medical Solutions	$744	20%
Caresource	$770	21%
Tricare	$868	24%
Three Rivers Providers Network	$1,404	38%
Healthsmart	$1,418	39%
Multiplan	$1,418	39%
Cigna	$1,433	39%

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 $17,151.
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 Charleston Area Medical Center 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.