CMS Price Transparency Data

Inguinal hernia repair

Facility: Great Plains Health

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $22,615
Cash Discount Price: $15,566
vs. Medicare Baseline: 6.18x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Great Plains Health is $22,615. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,566. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 6.18x the Medicare baseline. Located in 601 West Leota St, North Platte, NE.

Cash / Self-Pay

$15,566

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,615

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: $15,566 (426%)

Insurance Median: $22,615 (618%)

Cash: $15,566 (426% of Medicare)

Ins. Median: $22,615 (618% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 618% of the Medicare baseline (a markup of 518%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Nebraska Total Care	$491 - $3,626	13%
Molina	$536 - $3,956	15%
Blue Cross Blue Shield	$1,015 - $22,960	28%
Midlands Choice	$1,633 - $24,128	45%
Ambetter / Centene	$2,234 - $16,482	61%
Midwest Network Alliance	$21,837 - $22,615	597%
Medica	$23,868	652%
Oscar Health	$24,128	660%
Coventry	$24,387 - $24,647	667%
Geha	$24,387	667%
Mutual Of Omaha	$24,647	674%
UnitedHealthcare	$24,647	674%

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 $15,566.
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 Great Plains Health 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.