Inguinal hernia repair
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $3,371
- Cash Discount Price: $15,394
- vs. Medicare Baseline: 0.92x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $459 - $5,312 | 13% |
| Indian Health Service Contracted [320198] | $459 | 13% |
| Medicaid / KanCare | $1,121 - $3,436 | 31% |
| UnitedHealthcare | $3,008 - $3,436 | 82% |
| Humana | $3,143 - $3,371 | 86% |
| Aetna | $3,143 - $3,371 | 86% |
| Halo Hcr Inc Hospice Contracted [320432] | $3,371 | 92% |
| Kindful Hospice Contracted [320434] | $3,371 | 92% |
| Cross Timbers Hospice [20098] | $3,371 | 92% |
| Elara Caring Aspire Hospice [20433] | $3,371 | 92% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $3,371 | 92% |
| Halo Hcr Inc Hospice [20432] | $3,371 | 92% |
| Medicare (plans) | $3,371 - $3,508 | 92% |
| Kindful Hospice [20434] | $3,371 | 92% |
| Mercy Hospice Okc [20252] | $3,371 | 92% |
| Pace Of The Ozarks Contracted [320518] | $3,371 | 92% |
| Tricare | $3,371 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $3,371 | 92% |
| Home State Health Plan Contracted [320187] | $3,436 | 94% |
| Ambetter / Centene | $3,436 | 94% |
| Providrs Care Network Contracted [320484] | $6,528 | 178% |
| Health Choice Contracted [320166] | $7,058 | 193% |
Consumer Guidance & Cost Commentary
For this inguinal hernia repair at Mercy Hospital Pittsburg, Inc., the cash price of $15,394 is significantly lower than the facility's gross charge of $23,683, offering a substantial discount for patients paying out-of-pocket. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield range from $459 to $5,312, these amounts often exceed the cash price, meaning self-pay patients could save money by paying directly. It is important to note that cash payments may be more cost-effective for those with high-deductible plans if the insurance negotiated rate is higher than the cash price. Patients should verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront incentives can bypass administrative fees and reduce the final bill.
The facility's pricing is benchmarked against Medicare, which sets a baseline of $3,657.95 for this procedure. Commercial negotiated rates typically average 200% to 300% of Medicare, whereas fair pricing is generally defined as 120% to 150% of this rate. In this case, the median negotiated rate of $3,371 is below the 150% threshold, indicating a competitively priced contract compared to the national standard. However, patients must be aware that balance billing can still occur if out-of-network services are involved, even at an in-network facility. To avoid unexpected costs, consumers should request a detailed, itemized bill to review specific CPT codes and ensure no services were unbundled or incorrectly charged before finalizing payment.