Inguinal hernia repair
Facility: Ellinwood District Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $3,630
- Cash Discount Price: $4,407
- vs. Medicare Baseline: 0.99x 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 |
|---|---|---|
| Aetna | $3,630 | 99% |
| Humana | $3,630 | 99% |
| UnitedHealthcare | $3,630 | 99% |
| Blue Cross Blue Shield | $3,630 | 99% |
| Cigna | $3,630 | 99% |
Consumer Guidance & Cost Commentary
For the CPT code 49505, representing an inguinal hernia repair at Ellinwood District Hospital in Ellinwood, KS, the facility's negotiated rates for major payers like Aetna, Humana, and UnitedHealthcare are set at $3,630. This amount matches the median negotiated rate across the state and is identical to the facility's cash price of $4,407, indicating that paying out-of-pocket directly is actually more expensive than using insurance in this specific case. While the facility is a Critical Access Hospital with government ownership, the data shows no significant variance between the cash and negotiated amounts, meaning patients with high-deductible plans should be cautious about assuming self-pay will result in lower costs here, as the insurance rate is already at the floor.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify that all ancillary services, such as laboratory work or specific physician components, are also covered under the same network agreement to avoid unexpected secondary bills. If you choose to pay cash, you must explicitly request a "self-pay" or "prompt-pay" discount before scheduling your visit, as hospitals often default to submitting claims to insurance even when a patient intends to pay in full, which can void any potential cash savings. Given that the facility's rates align with the state median and the Medicare benchmark of $3,657.95, there is no indication of excessive markup, but consumers should always demand an itemized bill to ensure no unbundled charges or services not rendered are included in the final invoice.