CMS Price Transparency Data

Inguinal hernia repair

Facility: Gunnison Valley Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,015
Cash Discount Price: $1,899
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Gunnison Valley Hospital is $1,015. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,899. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.28x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$1,899

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,015

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: $1,899 (52%)

Insurance Median: $1,015 (28%)

Cash: $1,899 (52% of Medicare)

Ins. Median: $1,015 (28% 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
Medicaid / KanCare	$424	12%
Medicare (plans)	$517	14%
Gunnison County Sheriff Op & Profee Only	$548 - $1,745	15%
Ebms Hdhp	$641 - $2,040	18%
Tetwp Op & Profee Only-All Plans	$641 - $2,040	18%
U Of Co Transplant-All Plans	$641 - $2,040	18%
Ebms Ppo Plan-All Other Plans	$748 - $2,380	20%
Aetna	$749	20%
Apostrophe-All Plans	$853	23%
Cigna	$853	23%
Gunnison County Employees-All Other Plans	$854 - $2,720	23%
Scottish Rites-All Plans	$854 - $2,720	23%
Elap Employers-All Plans	$908 - $2,890	25%
Blue Cross Blue Shield	$936 - $2,980	26%
Multiplan-All Plans	$961 - $3,060	26%
Rocky Mountain Health-All Plans	$1,015 - $3,230	28%
UnitedHealthcare	$1,015 - $3,230	28%
Cofinity-All Plans	$1,025 - $3,264	28%

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 $1,899.
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 Gunnison Valley Hospital 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.