CMS Price Transparency Data

Inguinal hernia repair

Facility: Mercy Hospital Ada

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,527
Cash Discount Price: $10,745
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Mercy Hospital Ada is $3,527. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,745. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.96x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.

Cash / Self-Pay

$10,745

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,527

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: $10,745 (294%)

Insurance Median: $3,527 (96%)

Cash: $10,745 (294% of Medicare)

Ins. Median: $3,527 (96% 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	$488 - $3,529	13%
Aetna	$3,143 - $3,527	86%
Humana	$3,143 - $3,595	86%
Medicaid / KanCare	$3,143 - $4,854	86%
Cherokee Nation Health Serv Contracted [320066]	$3,527	96%
Cross Timbers Hospice [20098]	$3,527	96%
Dept Of Veteran Affairs Contracted [320106]	$3,527	96%
Elara Caring Aspire Hospice Contracted [320433]	$3,527	96%
Elara Caring Aspire Hospice [20433]	$3,527	96%
Halo Hcr Inc Hospice Contracted [320432]	$3,527	96%
Halo Hcr Inc Hospice [20432]	$3,527	96%
Independent Health [20197]	$3,527	96%
Indian Health Service Contracted [320198]	$3,527	96%
Kindful Hospice Contracted [320434]	$3,527	96%
Kindful Hospice [20434]	$3,527	96%
Medical Associates Health [20444]	$3,527	96%
Medicare (plans)	$3,527 - $3,595	96%
Mercy Hospice Okc [20252]	$3,527	96%
Provider Partners Health Plans Contracted [320450]	$3,527	96%
Qual Choice Contracted [320325]	$3,527	96%
Tricare	$3,527	96%
UnitedHealthcare	$3,527	96%
Globalhealth Contracted [320145]	$3,599	98%
Cigna	$3,635	99%
Ambetter / Centene	$4,854	133%
Home State Health Plan Contracted [320187]	$4,854	133%
Novasys Contracted [320285]	$4,854	133%
Workers Comp [20426]	$5,161	141%
Health Choice Contracted [320166]	$7,058	193%
Healthsmart Preferred Care Contracted [320184]	$7,936	217%
Kempton Contracted [320214]	$7,936	217%

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 $10,745.
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 Mercy Hospital Ada 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.