Inguinal hernia repair
Facility: Pratt Regional Medical Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $1,210
- Cash Discount Price: $847
- vs. Medicare Baseline: 0.33x 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 |
|---|---|---|
| Christian Health Aid | $182 - $4,389 | 5% |
| UnitedHealthcare | $201 - $5,969 | 5% |
| Health Partners Of Kansas | $206 - $4,974 | 6% |
| Aetna | $218 - $5,267 | 6% |
| Choicecare | $242 - $5,852 | 7% |
| Celtic Insurance Company | $3,206 | 88% |
| Healthy Blue | $3,303 | 90% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure (CPT 49505) at Pratt Regional Medical Center in Pratt, KS, the facility's cash price of $847.00 is notably lower than the state average, which sits at $1,210.00. While the facility's negotiated rates for commercial payers like UnitedHealthcare and Aetna range from $201 to $5,969, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying cash upfront rather than relying on insurance. It is important to note that the facility's negotiated rate of $1,210.00 matches the state average exactly, and the cash price represents a significant discount compared to the Medicare benchmark of $3,657.95, highlighting the potential for substantial savings when paying directly.
Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing costly insurance claims processing. Although the data does not provide a specific median paid amount or county-level averages for comparison, the facility's cash rate remains a strong reference point for understanding the true cost of care. To ensure you are not overcharged, request a detailed, itemized bill that breaks down every CPT code and service rendered, as summary bills often obscure errors or unbundled charges. Finally, remember that while the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities, it is always wise to verify your plan's specific allowed amounts and deductible status prior to receiving care.