CMS Price Transparency Data

Inguinal hernia repair

Facility: UW Health

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $530
Cash Discount Price: $414
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at UW Health is $530. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $414. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.14x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$414

Average discount available for prompt cash payment at this facility.

Insurance Median

$530

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: $414 (11%)

Insurance Median: $530 (14%)

Cash: $414 (11% of Medicare)

Ins. Median: $530 (14% 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
Aetna	$387 - $862	11%
Blue Cross Blue Shield	$387 - $2,589	11%
Medicaid / KanCare	$387	11%
Humana	$530	14%
Medicare (plans)	$530 - $583	14%
Mychoice Wi Medical Adv	$530	14%
UnitedHealthcare	$530 - $920	14%
Cigna	$981	27%
Alliance Premier Network	$1,038	28%
Quartz Fully Insured	$1,055	29%
The Alliance	$1,117	31%
Quartz Aso	$1,191	33%
Ecoh	$1,192 - $1,370	33%
Hfn	$1,192 - $1,370	33%
Wps	$1,295	35%
Beloit Healt System	$1,502	41%
Workers Comp	$1,784	49%
Mercy Care	$1,812	50%

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 $414.
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 UW Health 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.