CMS Price Transparency Data

Inguinal hernia repair

Facility: Boone County Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $797
Cash Discount Price: $917
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Boone County Hospital is $797. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $917. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.22x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$917

Average discount available for prompt cash payment at this facility.

Insurance Median

$797

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: $917 (25%)

Insurance Median: $797 (22%)

Cash: $917 (25% of Medicare)

Ins. Median: $797 (22% 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
Tricare	$437 - $480	12%
Choice Care Mcr Adv - All Plans	$451	12%
Humana	$451 - $1,080	12%
Iowa Hlth Adv - All Plans	$451	12%
Mt Carmel Hp - All Plans	$451	12%
Va Ccn-All Plans	$451	12%
Amerigroup Mcr Adv - All Other Plans	$456	12%
Aetna	$460 - $629	13%
UnitedHealthcare	$483 - $736	13%
Healthsmart Accell Network	$519	14%
Health Alliance-All Plans	$542	15%
Healthsmart Ppo - All Other Plans	$542	15%
Medical Associates Hp-All Plans	$858	23%
Wellmark Hmo	$1,001	27%
Health Partners Profee Only - All Plans	$1,006	28%
Mutually Preferred-All Plans	$1,038 - $1,140	28%
Meridian Mcaid - All Plans	$1,093 - $1,200	30%
Iowa Total Care Mcaid - All Plans	$1,115 - $1,224	30%
Midlands Choice-All Plans	$1,124	31%
Medicaid / KanCare	$1,126 - $1,236	31%
Wellmark Ppo - All Other Plans	$1,175	32%

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 $917.
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 Boone County Hospital 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.