Inguinal hernia repair
Facility: Wilson Medical Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $5,859
- Cash Discount Price: $5,576
- vs. Medicare Baseline: 1.60x 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 |
|---|---|---|
| Blue Cross Blue Shield | $3,774 - $7,544 | 103% |
| Aetna | $3,882 - $7,544 | 106% |
| UnitedHealthcare | $3,882 - $7,016 | 106% |
| Tricare | $3,882 - $3,998 | 106% |
| Ambetter / Centene | $3,882 - $7,544 | 106% |
| Humana | $3,882 - $3,998 | 106% |
| Cigna | $5,859 - $6,035 | 160% |
| Mulitplan-All Plans | $6,738 - $6,940 | 184% |
| Health Partners-All Plans | $6,738 - $6,940 | 184% |
Consumer Guidance & Cost Commentary
For this inguinal hernia repair at Wilson Medical Center in Neodesha, KS, the facility's cash median price of $5,576 is lower than the gross charge of $7,434, though it remains higher than the Medicare benchmark of $3,657.95. While the facility is a Critical Access Hospital with government local ownership, the negotiated rates for commercial payers like Blue Cross Blue Shield and Aetna range from approximately $3,882 to $7,544, which often exceeds the cash-pay option. Patients with high-deductible plans may find paying the cash median directly more cost-effective than relying on insurance, as the negotiated allowed amounts can sometimes surpass the cash price due to administrative overhead and contract structures.
To minimize costs, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing insurance processing fees. It is important to note that even though this facility is in-network for many plans, the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, but patients should still request an itemized billing audit to ensure no unbundled codes or services not rendered are included. Comparing the facility's pricing to regional standards, the cash rate sits above the state average for this procedure, suggesting that securing a prompt-pay discount or confirming the specific deductible status of your plan is essential before proceeding with treatment.