Inguinal hernia repair
Facility: Girard Medical Center
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $457
- Cash Discount Price: $1,003
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| Kansas Superior Select-All Plans | $457 | 12% |
| Humana | $457 | 12% |
| Aetna | $457 | 12% |
| Ambetter / Centene | $457 | 12% |
| UnitedHealthcare | $457 - $635 | 12% |
| Medicare (plans) | $457 | 12% |
| Blue Cross Blue Shield | $457 | 12% |
| Uhhis-All Plans | $635 | 17% |
| Multiplan-All Plans | $1,546 | 42% |
Consumer Guidance & Cost Commentary
For the CPT code 49505 (Inguinal hernia repair) at Girard Medical Center in Girard, KS, the facility's negotiated rates for commercial payers range from $457 to $635, with a median negotiated amount of $457. This rate is significantly lower than the facility's gross charge of $1,671, reflecting the contractual ceilings that protect in-network members. However, patients should be aware that while these negotiated rates are lower than the gross charge, they often exceed the cash price of $1,003. For individuals with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price or utilizing a prompt-pay discount may result in lower out-of-pocket costs compared to the insurance negotiated rate. It is crucial to verify the specific allowed amount with your insurer before scheduling, as rates can vary by plan, and to explicitly request self-pay or prompt-pay discounts prior to check-in to avoid automatic claims submission that would void any cash savings.
When evaluating the cost of this procedure, it is important to benchmark against the Medicare rate of $3,657.95, which serves as a scientifically validated baseline for the true cost of care. The facility's cash median of $1,003 and the median negotiated rate of $457 are substantially lower than the Medicare amount, indicating a fair pricing structure relative to federal standards. While the data provided does not include explicit state or county average comparisons for this specific code, the significant gap between the gross charge and the negotiated/cash rates demonstrates the value of understanding the difference between the hospital's list price and the actual amounts paid. Consumers are