CMS Price Transparency Data

Inguinal hernia repair

Facility: Tri Valley Health System

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,256
Cash Discount Price: $2,621
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Tri Valley Health System is $1,256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,621. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.34x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$2,621

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,256

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: $2,621 (72%)

Insurance Median: $1,256 (34%)

Cash: $2,621 (72% of Medicare)

Ins. Median: $1,256 (34% 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
Blue Cross Blue Shield	$452 - $2,712	12%
Humana	$452 - $1,256	12%
Medica Mcr Adv	$452 - $1,256	12%
Medica Prime Sol	$452 - $1,256	12%
Tricare	$452 - $1,256	12%
Wellcare Mcr Adv - All Plans	$465 - $1,256	13%
Aetna	$474 - $2,798	13%
Great Plains Mcr Adv - All Plans	$474 - $1,319	13%
Healthy Blue Mcaid - All Plans	$605 - $1,370	17%
Molina Mcaid - All Plans	$605 - $1,370	17%
UnitedHealthcare	$605 - $2,741	17%
Nebraska Total Care-All Plans	$611 - $1,370	17%
Amerigroup Mcaid - All Plans	$617 - $1,398	17%
Medica Ifb Aco	$885 - $2,570	24%
Medica Chi Aco - All Other Plans	$914 - $2,570	25%
Midlands Choice-All Plans	$924 - $2,570	25%
Medica Chi Open Access	$976 - $2,570	27%
Medica Ifb Open Access	$1,131 - $2,570	31%
Multiplan-All Plans	$1,459 - $2,798	40%

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 $2,621.
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 Tri Valley Health System 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.