Inguinal hernia repair
Facility: Kiowa District Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $6,741
- Cash Discount Price: $5,706
- vs. Medicare Baseline: 1.84x 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 |
|---|---|---|
| Tricare | $2,782 | 76% |
| Blue Cross Blue Shield | $3,774 | 103% |
| Healthchoice-All Plans | $5,286 | 145% |
| UnitedHealthcare | $5,706 - $7,133 | 156% |
| Health Partners Of Ks-All Plans | $6,277 | 172% |
| Humana | $6,438 | 176% |
| Gbs Insurance - All Plans | $6,705 | 183% |
| Multiplan-All Plans | $6,705 | 183% |
| Medicare (plans) | $6,776 | 185% |
| Aetna | $6,776 | 185% |
| Triwest-All Plans | $6,776 | 185% |
| Medicaid / KanCare | $7,133 | 195% |
| Providers Care (Wppa)-All Plans | $10,700 | 293% |
| Liberty Healthshare-All Plans | $11,520 | 315% |
Consumer Guidance & Cost Commentary
For this inguinal hernia repair at Kiowa District Hospital in Kiowa, Kansas, the cash price is $5,706, which is lower than the facility's negotiated rates for most major payers. While the hospital is a Critical Access Hospital owned by a government district, patients should be aware that commercial insurance contracts often result in higher allowed amounts than cash prices. For instance, UnitedHealthcare's negotiated rate ranges from $5,706 to $7,133, and UnitedHealthcare's average allowed amount is $6,705, which exceeds the cash price. This dynamic suggests that patients with high-deductible plans might save money by paying the cash price directly, provided they can afford the upfront cost and understand that their insurance may not cover the full difference.
To ensure you are not overcharged, it is crucial to request an itemized bill before paying, as summary bills can hide errors or unbundled charges. If you receive a balance bill from an out-of-network provider, the No Surprises Act may protect you from paying the difference between the provider's rate and your insurance's allowed amount, so do not sign away your rights to dispute such bills immediately. Additionally, since the facility is a Critical Access Hospital, you should ask specifically about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.