CMS Price Transparency Data

Inguinal hernia repair

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,198
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Atrium Health Navicent Rehabilitation Hopsital is $1,198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.33x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,198

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%)

Insurance Median: $1,198 (33%)

Ins. Median: $1,198 (33% 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	$501 - $3,529	14%
Blue Cross Blue Shield	$501 - $3,529	14%
Georgia Health Advantage	$501 - $3,529	14%
Humana	$501 - $4,453	14%
UnitedHealthcare	$501 - $3,529	14%
Care Source	$511 - $3,600	14%
Clover	$511 - $3,600	14%
Eon Health	$511 - $3,600	14%
Pruitt Health	$526 - $3,529	14%
Alliant	$601 - $2,773	16%
Ambetter / Centene	$676	18%
Cigna	$838 - $3,830	23%
Securehealth	$1,020	28%
Kaiser	$1,122 - $3,256	31%
Ibg	$1,294	35%

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 $X.
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 Atrium Health Navicent Rehabilitation Hopsital 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.