CMS Price Transparency Data

Inguinal hernia repair

Facility: Hermann Area District Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,381
Cash Discount Price: $1,408
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Hermann Area District Hospital is $1,381. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,408. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.38x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$1,408

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,381

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,657.95

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,657.95 (100%)

Cash / Self-Pay: $1,408 (38%)

Insurance Median: $1,381 (38%)

Cash: $1,408 (38% of Medicare)

Ins. Median: $1,381 (38% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Healthy Blue Mcaid - All Plans	$364	10%
Ambetter / Centene	$378 - $1,676	10%
Blue Cross Blue Shield	$392 - $1,938	11%
UnitedHealthcare	$392 - $1,000	11%
Care Partners Mcaid- All Plans	$562	15%
Tricare	$916 - $943	25%
Choicecare Mcr Adv- All Plans	$971 - $1,000	27%
American Hlth Mcr Adv- All Plans	$1,017 - $1,048	28%
Humana	$1,017 - $1,048	28%
Aetna	$1,038 - $2,262	28%
Wellcare Mcr Adv - All Plans	$1,038 - $1,069	28%
Harmony Hp Mcaid- All Plans	$1,341 - $1,381	37%
Healthcare Usa Mcaid- All Plans	$1,503 - $1,548	41%
Healthlink Hmo	$1,503 - $1,548	41%
Healthlink Ppo - All Other Plans	$1,734 - $1,786	47%
Multiplan/Phcs - All Plans	$1,734 - $1,786	47%
Coventry - All Plans	$1,965 - $2,024	54%
Comp Results - All Plans	$2,081 - $2,143	57%
Three Rivers - All Plans	$2,081 - $2,143	57%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,408.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 49505.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hermann Area District Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 49505.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.