Inguinal hernia repair
Facility: Rawlins County Health Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $1,266
- Cash Discount Price: $1,237
- vs. Medicare Baseline: 0.35x 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 |
|---|---|---|
| UnitedHealthcare | $1,266 | 35% |
| Blue Cross Blue Shield | $3,812 | 104% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure at Rawlins County Health Center in Atwood, Kansas, the cash price is $1,237.00, which is lower than the facility's negotiated rate of $1,266.00 paid by UnitedHealthcare and Blue Cross Blue Shield. This cash rate is also notably lower than the Medicare benchmark of $3,657.95, suggesting that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans or those without insurance. While the facility is a Critical Access Hospital, patients should verify if their specific plan has a deductible that would otherwise require them to pay the higher negotiated amount of $1,266.00 before insurance coverage begins.
To ensure you are not overcharged, it is important to understand that commercial insurance rates often include administrative costs and contract markups that can exceed the true cost of care. Since the cash price is already below the negotiated rates, there is no need to worry about balance billing from out-of-network providers for this specific service, as the No Surprises Act protects patients from such unexpected charges at in-network facilities. However, if you do receive a bill, always request a full itemized statement to check for errors, such as unbundled codes or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.