CMS Price Transparency Data
Inguinal hernia repair
Facility: Mercy Hospital Carthage
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $1,636
- Cash Discount Price: $2,169
- vs. Medicare Baseline: 0.45x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Mercy Hospital Carthage is $1,636. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,169. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.45x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$2,169
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,636
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: $2,169 (59%)
Insurance Median: $1,636 (45%)
Cash: $2,169 (59% of Medicare)
Ins. Median: $1,636 (45% 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.
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 |
|---|---|---|
| UnitedHealthcare | $477 - $4,633 | 13% |
| Medicaid / KanCare | $511 - $4,591 | 14% |
| Centivo Contracted [320505] | $517 | 14% |
| Medicare (plans) | $528 - $5,572 | 14% |
| Blue Cross Blue Shield | $556 - $5,058 | 15% |
| Cherokee Nation Health Serv Contracted [320066] | $562 - $917 | 15% |
| Cross Timbers Hospice [20098] | $562 - $917 | 15% |
| Elara Caring Aspire Hospice [20433] | $562 - $917 | 15% |
| Halo Hcr Inc Hospice Contracted [320432] | $562 - $917 | 15% |
| Halo Hcr Inc Hospice [20432] | $562 - $917 | 15% |
| Indian Health Service Contracted [320198] | $562 - $917 | 15% |
| Kindful Hospice Contracted [320434] | $562 - $917 | 15% |
| Kindful Hospice [20434] | $562 - $917 | 15% |
| Mercy Hospice Okc [20252] | $562 - $917 | 15% |
| Mercy Mgd Behavioral Health Contracted [320259] | $562 - $917 | 15% |
| Tricare | $564 - $920 | 15% |
| Aetna | $583 - $3,143 | 16% |
| Cigna | $583 - $768 | 16% |
| Globalhealth Contracted [320145] | $583 | 16% |
| Humana | $583 - $3,143 | 16% |
| Medical Associates Health Contracted [320444] | $583 | 16% |
| Pace Of The Ozarks Contracted [320518] | $583 | 16% |
| Provider Partners Health Plans Contracted [320450] | $583 | 16% |
| Qual Choice Contracted [320325] | $583 | 16% |
| Dept Of Veteran Affairs Contracted [320106] | $594 | 16% |
| Point C Contracted [320238] | $660 - $3,045 | 18% |
| Healthlink Contracted [320179] | $709 - $2,836 | 19% |
| Ambetter / Centene | $728 | 20% |
| Home State Health Plan Contracted [320187] | $728 | 20% |
| Novasys Contracted [320285] | $728 | 20% |
| Multiplan Contracted [320270] | $779 | 21% |
| Private Health Care Systems Contracted [320320] | $779 | 21% |
| First Health Contracted [320128] | $811 | 22% |
| Health Systems Inc Contracted [320174] | $879 - $1,692 | 24% |
| Insurance System Inc Contracted [320465] | $879 - $1,692 | 24% |
| Administrative Payor Contracted [320005] | $920 - $1,502 | 25% |
| Healthscope Contracted [320182] | $1,065 - $1,739 | 29% |
| United Medical Resources Contracted [320454] | $1,143 - $3,003 | 31% |
| Benefit Management Contracted [320052] | $1,227 - $2,903 | 34% |
| Auxiant Contracted [320462] | $1,329 - $2,836 | 36% |
| Preferred Health Plan Contracted [320522] | $1,329 - $2,169 | 36% |
| American Healthcare Alliance Contracted [320020] | $1,432 - $2,336 | 39% |
| Workers Comp [20426] | $1,636 - $3,337 | 45% |
| Aither Health Contracted [320449] | $1,738 - $2,836 | 48% |
| Ebms Contracted [320493] | $1,738 - $2,836 | 48% |
| Edison Health Solutions Contracted [320502] | $1,738 - $2,836 | 48% |
| Imagine 360 Contracted [320494] | $1,738 - $2,836 | 48% |
| Mercy Benefit Admin Contracted [320251] | $1,738 - $3,003 | 48% |
| Reflect Health Contracted [320492] | $1,738 - $2,836 | 48% |
| Show-Me Health Administrators Contracted [320483] | $1,738 - $2,836 | 48% |
| Yuzu Health Contracted [320521] | $1,738 - $2,836 | 48% |
| Evolutions Health Care Contracted [320124] | $1,779 - $2,903 | 49% |
| Ppo Plus Contracted [320310] | $1,840 - $3,003 | 50% |
| Usa Managed Care Org Contracted [320429] | $1,840 - $3,003 | 50% |
| Health Choice Contracted [320166] | $7,058 | 193% |