Inguinal hernia repair
Facility: Mcpherson Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $1,719
- Cash Discount Price: $1,272
- vs. Medicare Baseline: 0.47x 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 |
|---|---|---|
| Wppa - All Plans | $1,203 | 33% |
| Central Plains - All Plans | $1,289 | 35% |
| Medical Associates - All Plans | $1,289 | 35% |
| UnitedHealthcare | $1,341 - $3,293 | 37% |
| Christian Health Aid - All Plans | $1,375 | 38% |
| Aetna | $1,418 - $1,719 | 39% |
| Multiplan - All Plans | $1,547 | 42% |
| First Health - All Plans | $1,633 | 45% |
| Health Partners - All Plans | $1,633 | 45% |
| Cigna | $1,633 | 45% |
| Medicaid / KanCare | $1,719 | 47% |
| Health Blue Mcaid - All Other Plans | $1,753 | 48% |
| Tricare | $2,898 | 79% |
| Healthy Blue Mcr Adv | $3,293 | 90% |
| Humana | $3,293 | 90% |
| Va Ccn - All Plans | $3,293 | 90% |
| Wellcare Mcr Adv - All Plans | $3,293 | 90% |
| Blue Cross Blue Shield | $3,293 | 90% |
| Ambetter / Centene | $3,787 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 49505 (Inguinal hernia repair) at McPherson Hospital in McPherson, KS, the facility's cash median price is $1,272, while the negotiated rate paid by insurance carriers averages $1,719. This data highlights a scenario where paying cash directly can be more cost-effective than using insurance, as the negotiated rates exceed the cash price. Patients with high-deductible plans should consider paying out-of-pocket or utilizing "prompt-pay" discounts, which often range from 20% to 50% off the billed amount when settling upfront, to avoid the administrative overhead and higher administrative markups embedded in commercial contracts. It is important to verify if the facility offers a self-pay discount before scheduling, as waiting until after a claim is submitted may void the ability to negotiate a lower rate.
When evaluating this cost against the Medicare benchmark, the facility's negotiated rate of $1,719 represents a significant markup compared to the Medicare amount of $3,657.95 for this procedure, indicating that the commercial rate is lower than the federal baseline for this specific service. While commercial rates typically average 200% to 300% of Medicare across the industry, this specific code shows a negotiated rate that is lower than the Medicare amount, suggesting favorable pricing relative to the federal standard. However, patients must remain vigilant regarding balance billing; although the No Surprises Act protects against out-of-network balance billing at in-network facilities, unexpected charges for ancillary services or emergency care could still arise if not carefully reviewed. Consumers are advised to request a full itemized billing audit to ensure no unbundled codes or