Inguinal hernia repair
Facility: Hiawatha Community Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $608
- Cash Discount Price: $927
- vs. Medicare Baseline: 0.17x 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 |
|---|---|---|
| Ambetter / Centene | $426 | 12% |
| Humana | $457 | 12% |
| Aetna | $457 - $644 | 12% |
| UnitedHealthcare | $457 - $538 | 12% |
| Centrus Health Direct - All Plans | $548 | 15% |
| Preferred Hlth - All Plans | $588 | 16% |
| Wppa Providrs Care - All Plans | $608 | 17% |
| Multiplan - All Plans | $685 | 19% |
| Cigna | $727 | 20% |
| Oscar - All Plans | $731 | 20% |
| Healthy Blue Mcaid - All Plans | $763 - $1,090 | 21% |
| Midlands Choice - All Plans | $1,139 | 31% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure (CPT 49505) at Hiawatha Community Hospital in Hiawatha, KS, the cash median price is $927.00, which matches the facility's gross charge. This cash rate is significantly lower than the Medicare benchmark of $3,657.95, illustrating the substantial markup often found in commercial billing structures. While the hospital is a Critical Access Hospital with a voluntary non-profit ownership, patients should be aware that their specific insurance plan's negotiated rate may differ from the cash price. For instance, while the median negotiated rate across payers is $608.00, individual plans like Healthy Blue Mcaid have negotiated rates as high as $1,090, which exceeds the cash price. In scenarios where a patient has a high deductible and their insurance allows a negotiated rate higher than the cash price, paying out-of-pocket directly could result in lower immediate costs, provided the patient qualifies for the cash rate.
It is important to verify the exact status of your insurance plan before scheduling, as some in-network contracts may result in higher allowed amounts than others. The data shows a wide range of negotiated rates among the 12 participating payers, with the lowest being $426 for Ambetter / Centene and the highest reaching $1,139 for Midlands Choice. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims. Additionally, since over 80% of hospital bills contain errors, requesting