Inguinal hernia repair
Facility: Amberwell Atchison Association
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $553
- Cash Discount Price: $927
- vs. Medicare Baseline: 0.15x 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 | $411 - $553 | 11% |
| Va Ccn - All Plans | $457 | 12% |
| Triwest - All Plans | $457 | 12% |
| Humana | $457 - $612 | 12% |
| Superior Select Mcr Adv - All Plans | $457 | 12% |
| Centrus Health Direct - All Plans | $548 | 15% |
| Cigna | $568 | 16% |
| Aetna | $633 | 17% |
| Wppa Providrs Care - All Plans | $673 | 18% |
| Ambetter / Centene | $673 | 18% |
| Oscar - All Plans | $731 | 20% |
| Multiplan - All Plans | $868 | 24% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure (CPT 49505) at Amberwell Atchison Association, the cash price is $927.00, which matches the facility's cash median. This cash rate is significantly lower than the Medicare benchmark of $3,657.95, illustrating that commercial insurance negotiated rates often exceed the true cost of care. While the facility's negotiated rates for in-network payers range from $411 to $868, these amounts are generally lower than the Medicare amount but may still be higher than the cash price for patients with high-deductible plans. It is important to note that commercial insurance contracts include administrative overheads that can inflate the baseline price by 20% to 40% compared to direct cash payments.
Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among the 12 payers listed, with UnitedHealthcare offering the lowest range at $411 to $553 and Multiplan at the highest at $868. If your insurance deductible has not been met, you may end up paying the full negotiated rate, which could exceed the cash price of $927.00. To potentially reduce costs, you should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer fee reductions of 20% to 50% for upfront payment. Additionally, always request a full itemized bill before paying to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be resolved through a formal audit.