CMS Price Transparency Data

Inguinal hernia repair

Facility: Mercyone Dubuque Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,609
Cash Discount Price: $19,679
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Mercyone Dubuque Medical Center is $1,609. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,679. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.44x the Medicare baseline. Located in 250 Mercy Drive, Dubuque, IA.

Cash / Self-Pay

$19,679

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,609

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: $19,679 (538%)

Insurance Median: $1,609 (44%)

Cash: $19,679 (538% of Medicare)

Ins. Median: $1,609 (44% 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	$3,212	88%
Medicaid / KanCare	$3,244 - $3,256	89%
Aetna	$3,488	95%
Medicare (plans)	$3,488 - $3,630	95%
Blue Cross Blue Shield	$3,523	96%
UnitedHealthcare	$3,558	97%
Amish Hospital Aid	$4,734	129%
Oscar	$4,855	133%
Centivo	$5,574	152%
Ambetter / Centene	$5,979	163%
Claimdoc	$7,154	196%
Nova	$7,154	196%

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 $19,679.
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 Dubuque 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.