CMS Price Transparency Data

Inguinal hernia repair

Facility: Unitypoint Health - Meriter

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $1,550
Cash Discount Price: $3,515
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Unitypoint Health - Meriter is $1,550. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,515. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.42x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$3,515

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,550

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: $3,515 (96%)

Insurance Median: $1,550 (42%)

Cash: $3,515 (96% of Medicare)

Ins. Median: $1,550 (42% 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
Aspirus	$464 - $3,409	13%
Blue Cross Blue Shield	$464 - $10,922	13%
Illinicare	$464 - $3,409	13%
Prevea 360	$464 - $4,481	13%
UnitedHealthcare	$464 - $6,976	13%
Humana	$487 - $3,409	13%
Meridiancare	$487 - $3,409	13%
Health Partners Open Network	$962	26%
Cigna	$984 - $1,476	27%
Security Health Plan	$1,054 - $1,582	29%
Mercy Care	$1,230 - $1,845	34%
Medical Associates Health Plan	$1,541	42%
Wellmark Uph Self-Funded	$1,550 - $10,922	42%

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 $3,515.
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 Unitypoint Health - Meriter 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.