Inguinal hernia repair
Facility: Clay County Medical Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $940
- Cash Discount Price: $1,011
- vs. Medicare Baseline: 0.26x 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 |
|---|---|---|
| Health Partners - All Plans | $75 - $960 | 2% |
| Multiplan- All Plans | $469 - $960 | 13% |
| UnitedHealthcare | $531 - $960 | 15% |
| Aetna | $940 | 26% |
| Wppa/Providrs Care- All Plans | $940 | 26% |
Consumer Guidance & Cost Commentary
For the CPT code 49505 (Inguinal hernia repair) at Clay County Medical Center in Clay Center, KS, the cash median price is $1,011.00, which matches the facility's gross charge. This cash rate is significantly lower than the state average for this procedure, as indicated by the 30% variance noted in the data. While commercial payers like Health Partners and Multiplan have negotiated rates ranging from $469 to $960, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash rate of $1,011.00 directly, as this avoids the administrative overhead and markup associated with insurance billing cycles. It is important to verify if your specific plan has a deductible that would otherwise require you to pay the higher negotiated amount before scheduling.
The facility, a Critical Access Hospital owned by the local government, reports a median negotiated payment of $940.00, which aligns with the median allowed amount for UnitedHealthcare and Aetna. However, the Medicare benchmark for this service is $3,657.95, meaning the cash and negotiated rates are substantially below the federal baseline, suggesting a lower markup compared to typical commercial pricing structures. To ensure you are not subject to balance billing or unexpected charges, patients should request a full itemized bill before payment, as summary invoices can obscure individual code costs. Additionally, asking the billing department about prompt-pay discounts prior to check-in can further reduce the final cost, as these incentives are designed to bypass the costly claims processing that inflates insurance rates.