CMS Price Transparency Data

Inguinal hernia repair

Facility: Pulaski Memorial Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,017
Cash Discount Price: $1,390
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Pulaski Memorial Hospital is $1,017. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,390. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.28x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$1,390

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,017

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: $1,390 (38%)

Insurance Median: $1,017 (28%)

Cash: $1,390 (38% of Medicare)

Ins. Median: $1,017 (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
UnitedHealthcare	$371 - $3,282	10%
Ambetter / Centene	$460 - $1,017	13%
Blue Cross Blue Shield	$460 - $3,282	13%
Caresource Mcaid Hip	$460 - $1,017	13%
Caresource Mcare Hmo	$460 - $1,017	13%
Cenpatico Mcaid Hip	$460 - $1,017	13%
Humana	$460 - $2,638	13%
Mhs Mcaid Hip	$460 - $1,017	13%
Mhs Mcare Allwell	$460 - $1,028	13%
Multiplan - All Plans	$460 - $2,954	13%
Caresource Mcaid Hhw	$467 - $3,282	13%
Cenpatico Mcaid Hhw - All Other Plans	$467 - $3,282	13%
Mhs Mcaid Hhw/Hcc	$467 - $3,282	13%
Mdwise Mcaid Hcc	$469 - $3,282	13%
Mdwise Mcaid Hhw	$469 - $3,282	13%
Mdwise Mcaid Hip - All Other Plans	$469 - $1,017	13%
Cigna	$569 - $3,118	16%
Sagamore - All Other Plans	$569 - $2,481	16%
Sagamore Rose Acre	$569 - $2,445	16%
Caresource Exch Hmo Hix - All Other Plans	$575 - $1,272	16%
Encore Workers Comp	$620 - $2,954	17%
Encore Ppo - All Other Plans	$621 - $2,789	17%
Community Health Alliance - All Plans	$1,049 - $2,921	29%
Aetna	$1,181	32%

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 $1,390.
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 Pulaski Memorial 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.