CMS Price Transparency Data

Inguinal hernia repair

Facility: Modoc Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,577
Cash Discount Price: $3,915
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Modoc Medical Center is $3,577. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,915. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.98x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$3,915

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,577

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: $3,915 (107%)

Insurance Median: $3,577 (98%)

Cash: $3,915 (107% of Medicare)

Ins. Median: $3,577 (98% 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
Adv Med Mgmt - All Plans	$493	13%
Medi-Cal	$493	13%
Medi-Cal 7/1/24	$493	13%
Partnership Hp - All Plans	$1,727	47%
Blue Shield Comm - All Other Plans	$1,800	49%
Blue Shield Mcr Adv	$2,120	58%
Blue Shield Va	$2,120	58%
UnitedHealthcare	$2,120 - $3,719	58%
Tricare	$2,232	61%
Healthnet Mcr Adv	$2,254	62%
Blue Shield Exch	$3,218	88%
Blue Cross Blue Shield	$3,219 - $3,577	88%
Multiplan Wc	$3,475	95%
Carelon - All Plans	$3,577	98%
Ntwrks By Design Wc - All Plans	$3,621	99%
Integrated Hp Wc	$3,658	100%
Corvel - All Plans	$3,680	101%
Aetna	$3,719	102%
Coventry/First Health - All Plans	$3,719	102%
Galaxy Health - All Plans	$3,719	102%
Healthnet Comm - All Other Plans	$3,719	102%
Hmn - All Plans	$3,719	102%
Integrated Hp - All Other Plans	$3,719	102%
Interplan - All Plans	$3,719	102%
Multiplan - All Other Plans	$3,719	102%
Superior Ca Ppo - All Plans	$3,719	102%

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 $3,915.
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 Modoc 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.