Inguinal hernia repair
Facility: Wamego Health Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $452
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.12x 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 | $257 - $435 | 7% |
| Aetna | $267 - $452 | 7% |
| Medicaid / KanCare | $267 - $457 | 7% |
| Providrs Care | $632 | 17% |
| Tricare | $2,429 | 66% |
| Blue Cross Blue Shield | $5,412 - $5,696 | 148% |
Consumer Guidance & Cost Commentary
For the CPT code 49505 (Inguinal hernia repair) at Wamego Health Center in Wamego, KS, the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $257 to $457, while Medicaid/KanCare rates span $267 to $457. These commercial rates are significantly lower than the Medicare benchmark of $3,657.95, which serves as the federal baseline for "true cost" calculations. It is important to note that while commercial insurance contracts cap charges to protect members, these negotiated amounts often remain higher than cash prices due to administrative overhead and multi-layered billing structures. Patients with high-deductible plans should verify whether paying cash directly might result in lower out-of-pocket costs, as the facility does not publish a specific cash median, but prompt-pay discounts are frequently available for upfront payments.
The facility is a Critical Access Hospital in a rural setting, and while specific county or state average data for this procedure was not provided in the report, the wide variance in payer rates—from $2429 for Tricare to $5,696 for some Blue Cross Blue Shield plans—highlights the importance of checking individual plan details before scheduling. Consumers should be aware of balance billing risks if receiving care from out-of-network providers, though the No Surprises Act protects against such unexpected bills for emergency services at in-network facilities. To ensure the most accurate pricing, patients should request a full itemized bill to review specific CPT codes and avoid summary bills that may obscure unbundled charges or services not rendered. Additionally, asking the billing department about self-pay or prompt-pay