CMS Price Transparency Data

Inguinal hernia repair

Facility: Kossuth Regional Health Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,510
Cash Discount Price: $4,888
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Kossuth Regional Health Center is $1,510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,888. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.41x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$4,888

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,510

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: $4,888 (134%)

Insurance Median: $1,510 (41%)

Cash: $4,888 (134% of Medicare)

Ins. Median: $1,510 (41% 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
Humana	$451 - $4,127	12%
Va Ccn - All Plans	$451 - $4,086	12%
Amerigroup Mcr Adv - All Other Plans	$460 - $4,168	13%
UnitedHealthcare	$465 - $8,162	13%
Mercy One - All Plans	$474 - $4,086	13%
Sanford Pho Isno Mcr Adv Profee Only - All Plans	$474	13%
Medical Associates - All Plans	$745 - $9,140	20%
Preferred Health - All Plans	$745 - $9,140	20%
Aetna	$1,000 - $10,430	27%
Blue Cross Blue Shield	$1,023 - $4,826	28%
Health Partners New Bus - All Other Plans	$1,156 - $7,527	32%
Midlands Choice - All Plans	$1,242 - $7,527	34%
Health Partners Exisiting Bus	$1,271 - $10,430	35%
Multiplan - All Plans	$1,393 - $10,215	38%
Molina Mcaid/Chip - All Plans	$1,503 - $11,076	41%
Amerigroup Mcaid	$1,510 - $11,183	41%

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 $4,888.
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 Kossuth Regional Health 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.