Inguinal hernia repair
Facility: Holton Community Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $3,061
- Cash Discount Price: $2,705
- vs. Medicare Baseline: 0.84x 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 |
|---|---|---|
| Medicaid / KanCare | $411 - $5,718 | 11% |
| UnitedHealthcare | $411 - $5,718 | 11% |
| Aetna | $411 - $5,718 | 11% |
| Humana | $461 - $3,061 | 13% |
| Kansas Superior Select - All Plans | $466 - $3,091 | 13% |
| Blue Cross Blue Shield | $3,774 | 103% |
| Preferred Health Fn Select - All Other Plans | $4,746 | 130% |
| Preferred Health Freedom | $4,746 | 130% |
| Preferred Health Professionals | $4,746 | 130% |
| Wppa Providers - All Plans | $5,432 | 148% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure at Holton Community Hospital, the cash price of $2,705.00 is significantly lower than the facility's gross charge of $3,607.00. While the hospital's negotiated rates with major payers like Medicaid/KanCare, UnitedHealthcare, and Aetna range from $411 to $5,718, the cash rate remains the most affordable option for patients without insurance. This aligns with the principle that cash-pay can sometimes be cheaper for those with high-deductible plans if the insurance negotiated rate exceeds the cash price. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed by bypassing the administrative costs associated with insurance billing cycles.
When evaluating the cost of this service, it is important to compare the facility's rates against the Medicare benchmark rather than the inflated chargemaster list. The Medicare amount for this procedure is $3,657.95, which serves as the objective baseline for "true cost" evaluation. Although the facility's cash rate is lower than the Medicare amount, the wide variance in negotiated rates across different payers—such as the $461 to $3,061 range for Humana and the fixed $4,746 rate for several preferred health plans—highlights the importance of checking specific plan details before scheduling. Consumers should also be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, patients should still request an itemized bill to ensure no unbundled codes or services not rendered are included in the final invoice