Inguinal hernia repair
Facility: Great Plains Of Sabetha
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $3,797
- Cash Discount Price: $6,255
- vs. Medicare Baseline: 1.04x 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 - $7,302 | 11% |
| Aetna | $415 - $7,375 | 11% |
| UnitedHealthcare | $435 - $7,302 | 12% |
| Celtic Mcr Adv | $457 - $3,797 | 12% |
| Celtic Comm Exchange-All Other Plans | $571 - $4,746 | 16% |
| Great West Healthcare-All Plans | $1,102 - $6,207 | 30% |
| Century/Wppa/Providers-All Plans | $1,167 - $6,937 | 32% |
| Multiplan-Phcs-All Plans | $1,232 - $6,937 | 34% |
| Cigna | $1,232 - $6,937 | 34% |
| Humana | $1,232 - $6,937 | 34% |
| Federated Mutual Ins-All Plans | $1,245 - $7,010 | 34% |
| Blue Cross Blue Shield | $1,297 - $7,302 | 35% |
Consumer Guidance & Cost Commentary
For the inguinal hernia repair procedure (CPT 49505) at Great Plains Of Sabetha in Sabetha, KS, the cash median price is $6,255.00, which matches the facility's gross charge. This rate is significantly higher than the state average, as indicated by a Medicare benchmarking ratio of 1.0, meaning the facility's pricing aligns exactly with the federal government's cost-based standard rather than exceeding typical commercial markups. While the facility is a voluntary non-profit Critical Access Hospital, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, the median negotiated rate across payers is $4,746.00, yet many specific payer plans list maximums reaching up to $7,375.00. In scenarios where a patient has a high deductible or limited out-of-pocket coverage, paying the cash price directly may result in lower total costs compared to the insurance allowed amount, provided the patient secures a "self-pay" or "prompt-pay" discount before scheduling.
To minimize financial risk, patients should proactively request a written waiver of insurance submission and ask for the facility's specific prompt-pay discount, which can range from 20% to 50% for upfront payments. It is critical to avoid accepting summary bills that obscure individual line items, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients should verify that all ancillary services, such as laboratory tests or anesthesia,