CMS Price Transparency Data

Inguinal hernia repair

Facility: St Luke's McCall

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $9,148
Cash Discount Price: $12,945
vs. Medicare Baseline: 2.50x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at St Luke's McCall is $9,148. 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 2.50x the Medicare baseline. Located in 1000 State Street, McCall, ID.

Cash / Self-Pay

$12,945

Average discount available for prompt cash payment at this facility.

Insurance Median

$9,148

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: $9,148 (250%)

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

Ins. Median: $9,148 (250% 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 250% of the Medicare baseline (a markup of 150%). 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
Commercial [1028]	$5,005 - $16,570	137%
Medicare (plans)	$5,005 - $10,211	137%
Veterans Affairs [1056]	$5,005 - $10,011	137%
Blue Cross Blue Shield	$5,055 - $10,111	138%
Aetna	$5,506 - $16,397	151%
Moda [1055]	$7,594 - $15,189	208%
Cigna	$8,026 - $16,052	219%
Providence [1022]	$8,026 - $16,052	219%
First Health [1064]	$8,198 - $16,397	224%
Webtpa [1071]	$8,198 - $16,397	224%
Geha [1065]	$8,285 - $16,570	226%
United Medical Resources [1051]	$8,285 - $16,570	226%
UnitedHealthcare	$8,285 - $16,570	226%

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 McCall 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.