CMS Price Transparency Data

Inguinal hernia repair

Facility: Pinckneyville Community Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $8,391
Cash Discount Price: $7,899
vs. Medicare Baseline: 2.29x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Pinckneyville Community Hospital is $8,391. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,899. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.29x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$7,899

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,391

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: $7,899 (216%)

Insurance Median: $8,391 (229%)

Cash: $7,899 (216% of Medicare)

Ins. Median: $8,391 (229% 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 229% of the Medicare baseline (a markup of 129%). 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
Aetna	$299 - $20,410	8%
Ambetter / Centene	$299 - $19,233	8%
Blue Cross Blue Shield	$299 - $19,233	8%
Medicaid / KanCare	$299 - $19,233	8%
Umwa Mcr Adv - All Plans	$531 - $8,391	15%
UnitedHealthcare	$531 - $18,596	15%
Wellcare Mcr Adv - All Plans	$531 - $8,391	15%
Cigna	$637 - $18,709	17%
Healthlink Hmo	$1,233 - $17,802	34%
Healthlink Ppo - All Other Plans	$1,233 - $18,709	34%
Phcs Savility	$1,690 - $19,276	46%
Multiplan - All Plans	$1,789 - $20,410	49%
Phcs - All Other Plans	$1,789 - $18,596	49%
Humana	$4,375 - $8,391	120%
Healthlink Work Comp	$9,754 - $18,709	267%

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 $7,899.
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 Pinckneyville Community 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.