Inguinal hernia repair
Facility: Medicine Lodge Memorial Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $4,893
- Cash Discount Price: $5,150
- vs. Medicare Baseline: 1.34x 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 | $4,124 | 113% |
| Humana | $4,686 | 128% |
| Aetna | $4,764 - $5,150 | 130% |
| UnitedHealthcare | $4,892 | 134% |
| Hpk-All Plans | $4,892 | 134% |
| Medicaid / KanCare | $5,150 | 141% |
Consumer Guidance & Cost Commentary
For an inguinal hernia repair at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $5,150, which matches the facility's gross chargemaster rate. This cash amount is significantly higher than the state average for this procedure, reflecting the facility's status as a Critical Access Hospital with government ownership. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $4,686 to $5,150, these negotiated amounts often exceed the cash price. Patients with high-deductible plans should consider paying cash upfront, as the $5,150 cash rate may be cheaper than the insurer's allowed amount of up to $5,150, avoiding potential balance billing if the patient's plan does not cover the full negotiated rate.
To ensure you receive the most accurate pricing, it is crucial to request a full itemized bill before finalizing payment, as summary bills can obscure individual charges. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, verifying your specific plan's allowed amount is essential. Additionally, patients should ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the $5,150 cash price by 20% to 50% if paid in full within a short window. Since the facility is a government hospital district, standard commercial billing dynamics may apply differently, so confirming the final out-of-pocket cost with the billing department prior to scheduling is the most effective way to avoid unexpected expenses.