CMS Price Transparency Data

Inguinal hernia repair

Facility: Forks Community Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $4,506
Cash Discount Price: $7,466
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Forks Community Hospital is $4,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,466. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.23x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$7,466

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,506

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: $7,466 (204%)

Insurance Median: $4,506 (123%)

Cash: $7,466 (204% of Medicare)

Ins. Median: $4,506 (123% 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
Medicare (plans)	$318	9%
Medicaid / KanCare	$2,992 - $3,670	82%
Coordinated Care (Mco) Mcd-All Plans	$3,231 - $3,740	88%
UnitedHealthcare	$3,850 - $8,511	105%
Community Health Network Mcr-All Other Plans	$3,893 - $4,506	106%
Humana	$3,893 - $4,506	106%
Tricare	$3,893 - $4,506	106%
Triwest-All Plans	$3,893 - $4,506	106%
Ambetter / Centene	$4,516 - $5,227	123%
Wellcare Med Adv - All Plans	$4,516 - $5,227	123%
Regence-All Other Plans	$4,981 - $5,765	136%
Community Health Exchange	$5,623 - $6,508	154%
Molina Commercial-All Other Plans	$7,959 - $9,212	218%
Blue Cross Blue Shield	$8,218 - $9,512	225%
Aetna	$8,651 - $10,013	236%
Cigna	$8,651 - $10,013	236%
First Choice-All Plans	$8,651 - $10,013	236%

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 $7,466.
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 Forks Community 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.