Inguinal hernia repair
Facility: Memorial Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $480
- Cash Discount Price: $857
- vs. Medicare Baseline: 0.13x 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 |
|---|---|---|
| Tricare | $457 | 12% |
| Ambetter / Centene | $502 | 14% |
Consumer Guidance & Cost Commentary
For this inguinal hernia repair at Memorial Hospital in Abilene, KS, the cash price is $857, which matches the facility's median negotiated rate. This amount is significantly lower than the Medicare benchmark of $3,657.95, indicating a substantial discount from the federal baseline. While the facility is a Critical Access Hospital with a government ownership structure, the data shows no specific county or state average provided for comparison. Patients with high-deductible plans may find this cash price advantageous if their insurance negotiated rate exceeds $857, as paying out-of-pocket could result in immediate savings compared to the administrative costs and potential deductibles associated with using commercial insurance.
It is important to verify the final cost before scheduling, as commercial insurance rates can vary significantly even within the same network. Although the data indicates a single negotiated rate of $480 for Ambetter/Centene and $457 for Tricare, these figures represent the payer's allowed amount, not necessarily the final patient responsibility. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront, bypassing the costly claims processing cycle. Additionally, since over 80% of hospital bills contain errors, consumers should request a detailed, itemized statement to ensure no services were double-billed or unbundled before settling the account.