Inguinal hernia repair
Facility: Trego County Lemke Memorial Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $4,250
- Cash Discount Price: $4,250
- vs. Medicare Baseline: 1.16x 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 |
|---|---|---|
| Humana | $2,450 | 67% |
| Tricare | $2,646 | 72% |
| Medicaid / KanCare | $3,100 - $5,000 | 85% |
| Aetna | $3,100 - $4,500 | 85% |
| Va Ccn - All Plans | $3,100 | 85% |
| UnitedHealthcare | $3,100 - $5,000 | 85% |
| Ambetter / Centene | $3,410 | 93% |
| Health Partners - All Plans | $4,750 | 130% |
| Healthy Blue Mcaid - All Plans | $5,000 | 137% |
| Blue Cross Blue Shield | $5,635 | 154% |
Consumer Guidance & Cost Commentary
Trego County Lemke Memorial Hospital, located at 320 N Thirteenth St in Wakeeney, KS, provides pricing data for an inguinal hernia repair. The facility's cash median rate is $4,250, which aligns with the median negotiated rate of $4,250 and the Medicare amount of $3,657.95. While the gross charge listed is $5,000, the median paid amount across payers is $3,100. For comparison, the state average for this procedure is 20% higher than the facility's cash rate, and the county average is 10% higher. Medicare reimbursement serves as a benchmark of $3,657.95, which is approximately 1.2 times the facility's cash rate.
Patients should consider that cash-pay options can sometimes be more cost-effective than insurance claims, particularly if a specific insurance plan's negotiated rate exceeds the cash price. Although the median negotiated rate is $4,250, individual payer rates vary significantly; for instance, Blue Cross Blue Shield has a high rate of $5,635, while Medicaid/KanCare ranges from $3,100 to $5,000 depending on the plan. Consumers are encouraged to request "self-pay" or "prompt-pay" discounts directly from the hospital before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, patients should request an itemized billing audit to verify that all charges are accurate and that no services were unbundled or incorrectly billed.