CMS Price Transparency Data

Inguinal hernia repair

Facility: Mercyone North Iowa Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,658
Cash Discount Price: $35,261
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Mercyone North Iowa Medical Center is $3,658. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35,261. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.00x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$35,261

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,658

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: $35,261 (964%)

Insurance Median: $3,658 (100%)

Cash: $35,261 (964% of Medicare)

Ins. Median: $3,658 (100% 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
Iowa Total Care	$3,464	95%
Medicaid / KanCare	$3,498 - $3,512	96%
Bcn Domestic	$3,658	100%
Blue Benefit Administrators Of Massachusetts	$3,658	100%
Blue Care Network	$3,658	100%
Blue Cross Blue Shield	$3,658 - $3,820	100%
Blue Distinction Transplant	$3,658	100%
Blue Shield - Ca	$3,658	100%
Blue Shield - Id (Regence)	$3,658	100%
Blue Shield - Ny Highmark Northeastern	$3,658	100%
Blue Shield - Ny Highmark Western	$3,658	100%
Blue Shield - Pa (Highmark)	$3,658	100%
Blue Shield - Wa (Regence)	$3,658	100%
Kaiser Domestic	$3,658	100%
Pre-Employment	$3,658	100%
Wc Domestic	$3,658	100%
Aetna	$3,782	103%
Medicare (plans)	$3,782 - $3,936	103%
UnitedHealthcare	$3,858	105%
Centivo	$4,747	130%
Oscar	$5,087	139%
Amish Hospital Aid	$5,133	140%
Ambetter / Centene	$6,483	177%
Claimdoc	$7,757	212%
Nova	$7,757	212%

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 $35,261.
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 Mercyone North Iowa Medical Center 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.