Inguinal hernia repair
Facility: Greeley County Health Services
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $452
- Cash Discount Price: $3,779
- vs. Medicare Baseline: 0.12x 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 |
|---|---|---|
| Aetna | $245 - $452 | 7% |
| Medicaid / KanCare | $245 - $452 | 7% |
| Blue Cross Blue Shield | $4,946 | 135% |
Consumer Guidance & Cost Commentary
For the inguinal hernia repair procedure (CPT 49505) at Greeley County Health Services in Tribune, Kansas, the cash median price is $3,779.00, which is lower than the facility's gross charge of $5,399.00. While the facility is in-network for Aetna and Medicaid/KanCare, with negotiated rates ranging from $245 to $452, and Blue Cross Blue Shield with a fixed rate of $4,946, patients should be aware that insurance payments can sometimes exceed the cash price depending on their specific plan's deductible and out-of-pocket maximums. In this case, the cash rate is notably lower than the Blue Cross Blue Shield negotiated rate, meaning a patient with a high deductible might save money by paying the cash price directly, provided they secure a prompt-pay discount before the claim is submitted.
To maximize savings, patients should explicitly request a self-pay or prompt-pay discount prior to scheduling, as waiting until after receiving an insurance bill may result in the loss of these upfront fee reductions. It is important to note that while the facility is a Critical Access Hospital with government-local ownership, the negotiated rates for Medicaid/KanCare and Aetna are significantly lower than the cash price, suggesting that insurance coverage may be beneficial for those without substantial out-of-pocket limits. However, if a patient's insurance allowed amount is higher than the cash rate, paying the cash price upfront could still result in a lower total cost, making it essential to compare the specific allowed amounts against the cash median before finalizing payment plans.