49591

Initial repair of sliding hernia of abdomen, less than 3 cm in length

Medicare pricing data for 10,061 providers across 51 states

🤖AI Overview

This procedure has a 5.4x markup — hospitals charge $1,777 but Medicare allows only $331.57. Uninsured patients may face bills 5.4 times higher than what insurance negotiates. Prices vary significantly by location — from $189 in South Dakota to $545 in Wyoming. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Initial repair of sliding hernia of abdomen, less than 3 cm in length (HCPCS code 49591) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $331.57, but hospitals typically charge $1,777 — a 5.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$66.31

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $331.57, your out-of-pocket cost would be approximately $66.31. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$331.57
Average Hospital Charge
$1,777
Markup Ratio
5.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$1,776.79
Medicare Allowed$331.57
Medicare Payment$260.98

Hospitals charge 5.4x more than what Medicare allows for this procedure. Medicare actually pays $260.98 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Wyoming$545$3,6923587+64.5%
California$434$2,7548202,179+30.8%
Alaska$419$4,8103883+26.4%
Colorado$409$1,707221471+23.4%
Indiana$392$2,221258614+18.3%
Nebraska$390$1,81495253+17.7%
Arizona$365$2,003195548+10.2%
Minnesota$365$1,999225412+9.9%
Kansas$350$1,396124400+5.4%
Illinois$349$1,928362877+5.3%
Virginia$345$1,317270728+4.1%
Florida$342$1,7676721,730+3.1%
Ohio$341$1,918388845+2.9%
Maryland$340$1,593194478+2.7%
Oregon$340$1,606137249+2.4%
New Mexico$338$1,8235291+2.0%
North Carolina$338$1,609327787+1.9%
Washington$336$1,398243529+1.3%
Texas$335$2,1096251,313+1.1%
Iowa$332$1,447136327+0.3%
South Carolina$329$1,740163473-0.7%
Louisiana$329$1,959144315-0.8%
Mississippi$325$907100236-2.1%
Montana$319$99852134-3.7%
Missouri$311$1,336197411-6.1%
Kentucky$310$1,059153338-6.4%
Arkansas$305$971101243-8.1%
New Jersey$303$3,491216493-8.5%
Alabama$298$1,296149306-10.2%
Tennessee$297$1,190206447-10.3%
Utah$296$1,196113284-10.9%
Georgia$293$1,426276616-11.6%
Massachusetts$290$1,286257623-12.6%
Oklahoma$289$825121286-12.8%
Wisconsin$288$2,718239480-13.2%
Nevada$287$1,83185198-13.3%
Pennsylvania$286$1,0134681,046-13.6%
New Hampshire$284$2,01678174-14.2%
Connecticut$281$1,514116204-15.3%
Rhode Island$280$9573051-15.6%
Michigan$278$1,109306581-16.3%
Idaho$277$1,00676184-16.5%
North Dakota$276$1,4073570-16.9%
New York$269$2,0735971,289-18.8%
Vermont$268$1,3252776-19.1%
Hawaii$266$1,0062843-19.8%
West Virginia$236$87957109-28.9%
District of Columbia$204$9093478-38.4%
Delaware$204$98851121-38.4%
Maine$198$82446100-40.2%
South Dakota$189$76661166-43.0%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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