CMS Price Transparency Data

Inguinal hernia repair

Facility: Madison County Health Care System

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 49505
  • Insurance Median: $3,284
  • Cash Discount Price: $3,642
  • vs. Medicare Baseline: 0.90x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Madison County Health Care System is $3,284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,642. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.90x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.
Cash / Self-Pay
$3,642

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,284

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: $3,642 (100%)
Insurance Median: $3,284 (90%)
Cash: $3,642 (100% of Medicare)
Ins. Median: $3,284 (90% 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.

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
Midlands Choice - All Plans $64 - $7,485 2%
Aetna $451 - $4,965 12%
Choicecare-All Plans $451 - $7,256 12%
Medical Associates Hp - All Plans $451 - $3,284 12%
Medigold-All Plans $451 - $3,284 12%
Medimore Employee Hp - All Plans $451 - $7,485 12%
Tricare $451 - $3,284 12%
UnitedHealthcare $451 - $6,874 12%
American Hp Mcr Adv-All Plans $474 - $3,449 13%
Madison County Sheriff-All Plans $734 - $3,819 20%
Oscar - All Plans $781 - $4,927 21%
Blue Cross Blue Shield $946 - $6,192 26%
Corvel Wc-All Plans $1,321 - $6,874 36%
First Choice-All Plans $1,395 - $7,256 38%
First Health-All Plans $1,395 - $7,256 38%
Integrated Hp-All Plans $1,395 - $7,256 38%
Mutual Of Omaha-All Plans $1,395 - $7,256 38%
Plaines Health-All Plans $1,395 - $7,256 38%
Preferred Hlth Ntwork-All Plans $1,395 - $7,256 38%
Principal Healthcare-All Plans $1,395 - $7,256 38%
Usa Managed Care-All Plans $1,395 - $7,256 38%
Benefit Admin Of America-All Plans $1,468 - $7,638 40%
Iowa Total Care Mcaid-All Plans $1,468 - $3,590 40%
Molina Mcaid/Chip -All Plans $1,505 - $3,716 41%
Amerigroup Mcaid-All Plans $1,556 - $3,805 43%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 300 West Hutchings Street, Winterset, IA 50273
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals