CMS Price Transparency Data

Inguinal hernia repair

Facility: St Luke's Nampa Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $7,336
Cash Discount Price: $12,945
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at St Luke's Nampa Medical Center is $7,336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,945. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.01x the Medicare baseline. Located in 9850 West St Lukes Drive, Nampa, ID.

Cash / Self-Pay

$12,945

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,336

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: $12,945 (354%)

Insurance Median: $7,336 (201%)

Cash: $12,945 (354% of Medicare)

Ins. Median: $7,336 (201% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$3,373 - $20,965	92%
Commercial [1028]	$3,373 - $20,965	92%
Mountain Health Co-Op [1067]	$3,373 - $11,219	92%
Pacificsource [1020]	$3,373 - $11,219	92%
Select Health [1063]	$3,373 - $11,219	92%
Slplan Tap Mc St Lukes Health Plan [1641000001]	$3,373 - $11,219	92%
St Lukes Health Plan [1046]	$3,373 - $11,219	92%
UnitedHealthcare	$3,798 - $14,153	104%
Aetna	$6,904 - $15,534	189%
Cigna	$6,904 - $13,808	189%
Providence [1022]	$6,904 - $13,808	189%
Webtpa [1071]	$6,904 - $14,671	189%
Geha [1065]	$7,077 - $14,153	193%
United Medical Resources [1051]	$7,077 - $14,153	193%
First Health [1064]	$7,120 - $14,671	195%
Moda [1055]	$7,594 - $15,189	208%
Blue Shield Alt [100401]	$10,482 - $20,965	287%
Regence Out Of State [1004]	$10,482 - $20,965	287%
Regence [1005]	$10,482 - $20,965	287%

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 $12,945.
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 St Luke's Nampa 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.