Inguinal hernia repair
Facility: William Newton Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $457
- Cash Discount Price: $1,276
- 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 |
|---|---|---|
| Ambetter / Centene | $411 - $525 | 11% |
| Triwest- All Plans | $434 | 12% |
| UnitedHealthcare | $457 | 12% |
| Blue Cross Blue Shield | $457 | 12% |
Consumer Guidance & Cost Commentary
For an inguinal hernia repair at William Newton Hospital in Winfield, KS, the cash price of $1,276.00 is significantly lower than the facility's Medicare benchmark of $3,657.95, representing a 65% reduction. While commercial insurance plans like Ambetter / Centene, Triwest, UnitedHealthcare, and Blue Cross Blue Shield negotiate rates ranging from $411 to $457, these amounts are still higher than the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the negotiated rates often exceed the cash amount due to administrative overheads embedded in insurance contracts. It is important to note that while the facility is a Critical Access Hospital with a government-local ownership structure, the cash rate remains the most transparent baseline for comparison against state averages.
Before scheduling, patients should proactively request "self-pay" or "prompt-pay" discounts from the billing department, as these upfront payment incentives can further reduce the final cost by bypassing the administrative fees associated with insurance claims processing. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify that all ancillary services, such as laboratory tests or anesthesia, are covered under the same negotiated framework to avoid unexpected charges. Consumers are encouraged to review their specific plan details to confirm deductible status and ensure they are not inadvertently paying the full negotiated rate before meeting their out-of-pocket thresholds.