Inguinal hernia repair
Facility: Community Memorial Healthcare, Inc.
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $633
- Cash Discount Price: $1,392
- 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 |
|---|---|---|
| UnitedHealthcare | $265 - $502 | 7% |
| Aetna | $457 - $1,113 | 12% |
| Blue Cross Blue Shield | $761 - $4,120 | 21% |
Consumer Guidance & Cost Commentary
For an inguinal hernia repair at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $1,392, which matches the facility's median paid amount. This cash rate is significantly lower than the Medicare benchmark of $3,657.95, representing a 63% discount compared to the federal standard. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, Aetna's negotiated range spans from $457 to $1,113, and Blue Cross Blue Shield's range extends up to $4,120, meaning a patient with a high deductible might save money by paying the cash price directly rather than relying on insurance reimbursement, provided they have not yet met their deductible.
It is important to verify your specific plan's negotiated rates before scheduling, as in-network allowances vary widely among payers. The data shows that UnitedHealthcare offers a lower range of $265 to $502, while Blue Cross Blue Shield's upper limit of $4,120 suggests potential variability in allowed amounts depending on the specific plan. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized statement before payment is crucial to identify any unbundled codes or services not rendered, ensuring you are only paying for the actual care provided.