CMS Price Transparency Data

Inguinal hernia repair

Facility: Madison County Health Care System

Billing Code: 49505 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$728

about 0.2× the $3,658 Medicare rate · typically $447–$1,939

modeled estimate · not a bill or quote

What this hospital charges insurers

$727

About the fair price

about $1 under the fair price · 0.2× Medicare

Medicare pays $3,658 Fair price $728 This hospital $727 Cash price $3,642 Hospital's list price $4,553

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

Highest price of the 9 IA hospitals we have prices for — worth calling around.

Cheapest $451 Priciest $727

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Inguinal hernia repair is about $728 (about 0.2× the $3,658 Medicare rate). Madison County Health Care System charges insurers about $727, or about $3,642 in cash — about the fair price. Located in Winterset, IA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$451 - $6,874	12%
Blue Cross Blue Shieldmajor	$946 - $6,192	26%
Aetnamajor	$451 - $4,965	12%
Amerigroup	$1,556 - $3,805	43%
Molina	$1,505 - $3,716	41%
Oscar Health	$781 - $4,927	21%
+ 14 smaller / regional plans	$451 - $7,638

Government programs also on file: Military & VA.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,642), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 49505.

Insurance Before you use insurance

Call your insurance company to confirm Madison County Health Care System is in-network.
Ask your insurer whether prior approval is required for CPT code 49505.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Madison County Health Care System

Compare: Inguinal hernia repair at other IA hospitals

Waverly Health Center · Waverly $451
Mahaska Health Partnership · Oskaloosa $451
Guthrie County Hospital · Guthrie Center $456
Virginia Gay Hospital · Vinton $456
Story County Hospital · Nevada $464
Cass County Memorial Hospital · Atlantic $497
Clarke County Hospital · Osceola $533
Winnmed · Decorah $560

Insurance negotiated median for the same procedure, sorted lowest first.