Inguinal hernia repair
Facility: Oakleaf Surgical Hospital
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $3,546
- Cash Discount Price: $12,333
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $3,546 - $9,999 | 97% |
| Dean Health Plan | $3,546 | 97% |
| Group Health Cooperative Of Eau Claire | $3,546 | 97% |
| Healthpartners | $3,546 | 97% |
| Humana | $3,546 | 97% |
| Medica | $3,546 | 97% |
| Quartz Health Solutions | $3,546 | 97% |
| Security Health Plan Of Wi | $3,546 - $6,283 | 97% |
| Ucare Wi | $3,546 | 97% |
| UnitedHealthcare | $3,546 | 97% |
Consumer Guidance & Cost Commentary
For an inguinal hernia repair at Oakleaf Surgical Hospital in Altoona, WI, the cash median price is $12,333. This facility, owned by physicians, has a negotiated rate of $3,546 for in-network patients, which is significantly lower than the cash option. While the gross charge listed is $13,703, the actual cost for patients paying out-of-pocket is the cash median of $12,333. Because the negotiated rate of $3,546 is much lower than the cash price, patients with active insurance coverage will almost certainly pay less than those paying cash, unless they have a high deductible that prevents them from using their plan immediately.
The Medicare amount for this procedure is $3,657.95, which serves as a baseline for fair pricing comparisons. Although specific county or state average data is not provided in this dataset, the facility's cash rate of $12,333 is notably higher than the Medicare benchmark. Patients should be aware that prompt-pay discounts, which can reduce bills by 20% to 50% for upfront payment, may be available if requested before scheduling. To ensure you receive the best possible rate, verify your deductible status and ask the hospital directly about self-pay or prompt-pay discounts before allowing an automatic claim submission to your insurance provider.