Inguinal hernia repair
Facility: Cloud County Health Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $715
- Cash Discount Price: $600
- vs. Medicare Baseline: 0.20x 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 |
|---|---|---|
| Mpi-All Plans | $617 | 17% |
| Pponext-All Plans | $814 | 22% |
Consumer Guidance & Cost Commentary
For an inguinal hernia repair at Cloud County Health Center in Concordia, KS, the cash median price is $600, which is lower than the facility's negotiated rate of $715 and the median paid by insurers at $814. While the facility is a Critical Access Hospital with a voluntary non-profit ownership, patients with high-deductible plans may find paying the $600 cash price more cost-effective if their insurance negotiated rate exceeds this amount, as the administrative costs of processing claims often inflate the final bill. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not subject to unexpected charges.
The Medicare benchmark for this procedure is $3,657.95, which serves as the objective baseline for evaluating the facility's pricing markup. The facility's gross charge of $857 is significantly lower than the Medicare amount, indicating a transparent pricing structure that does not rely on inflated chargemaster lists to generate revenue. However, patients should avoid comparing their potential savings against the gross charge, as this can be misleading; instead, they should compare their out-of-pocket costs against the Medicare rate to understand the true cost of care. If a patient receives an itemized bill that includes errors, double-billing, or unbundled codes, they should request a formal written audit dispute sent via certified mail to the billing supervisor rather than accepting a summary bill or settling verbally.