Inguinal hernia repair
Facility: Smith County Memorial Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $5,502
- Cash Discount Price: $5,853
- vs. Medicare Baseline: 1.50x 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 |
|---|---|---|
| Blue Cross Blue Shield | $3,774 | 103% |
| Medicaid / KanCare | $4,097 - $5,853 | 112% |
| Multiplan-All Plans | $5,268 | 144% |
| Wppa-All Plans | $5,502 | 150% |
| UnitedHealthcare | $5,561 | 152% |
| Health Partners Of Ks Ppo-All Plans | $5,561 | 152% |
| Midlands Choice-All Plans | $5,561 | 152% |
Consumer Guidance & Cost Commentary
For the CPT code 49505, inguinal hernia repair, Smith County Memorial Hospital in Smith Center, KS, lists a cash median price of $5,853.00, which matches the facility's gross charge. This cash rate is significantly higher than the Medicare benchmark of $3,657.95, reflecting a markup of 1.5 times the federal baseline. While commercial insurance plans like Medicaid/KanCare negotiate rates ranging from $4,097 to $5,853, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket if they qualify for self-pay or prompt-pay discounts. It is important to note that commercial rates can vary widely by payer, with some plans paying up to $5,561 while others, such as Blue Cross Blue Shield, pay the lowest negotiated amount of $3,774.
Patients should be aware that hospitals often inflate their chargemaster lists to make insurance discounts appear larger, so comparing rates directly to the Medicare amount provides a more accurate view of the facility's pricing structure. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify your specific plan's deductible status before scheduling, as you may still be responsible for the full negotiated amount if you have not yet met your out-of-pocket threshold. To ensure you receive the most favorable rate, we recommend contacting the hospital directly to confirm whether a prompt-pay discount is available for upfront payment, as these incentives can bypass the administrative costs associated with insurance claims processing.