Inguinal hernia repair
Facility: Hospital District #6 Patterson Health Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $517
- Cash Discount Price: $440
- vs. Medicare Baseline: 0.14x 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 | $484 - $550 | 13% |
Consumer Guidance & Cost Commentary
For the CPT code 49505, representing an inguinal hernia repair at Hospital District #6 Patterson Health Center in Anthony, KS, the cash median price is $440.00, which is lower than the facility's gross charge of $550.00. While the facility is a Critical Access Hospital owned by the government, the cash rate is notably lower than the Medicare benchmark of $3,657.95. This significant difference highlights that commercial negotiated rates often exceed the true cost baseline established by Medicare; in this case, the facility's cash price is roughly 12% of the Medicare amount, suggesting that paying out-of-pocket could be a financially advantageous option for patients with high-deductible plans who have not yet met their coverage thresholds.
The median negotiated rate for this service is $517.00, which is higher than the cash price but still below the gross charge. Since there is only one payer listed (UnitedHealthcare) with a range of $484 to $550, patients should verify their specific plan's allowed amount before scheduling. It is important to note that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should still request a "self-pay" or "prompt-pay" discount prior to check-in to ensure they receive the lowest possible rate. Given that over 80% of hospital bills contain errors, patients are encouraged to request a full itemized CPT-coded bill to review every charge and avoid paying for services that were not rendered or codes that were unbundled.