CMS Price Transparency Data

Inguinal hernia repair

Facility: Tomah Memorial Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $453
Cash Discount Price: $1,001
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Tomah Memorial Hospital is $453. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,001. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.12x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$1,001

Average discount available for prompt cash payment at this facility.

Insurance Median

$453

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: $1,001 (27%)

Insurance Median: $453 (12%)

Cash: $1,001 (27% of Medicare)

Ins. Median: $453 (12% 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
Blue Cross Blue Shield	$86 - $1,144	2%
Independent Care Mcaid	$86	2%
Managed Hlth Mcaid - All Plans	$86	2%
Quartz Mcaid	$86	2%
Security Hp Mcaid	$86	2%
UnitedHealthcare	$385 - $751	11%
Group Hlth Mcr Adv - All Plans	$453	12%
Independent Care Mcr - All Other Plans	$453	12%
Quartz Mcr Adv	$453	12%
Security Hp Mcr Adv	$453	12%
Va Ccn - All Plans	$453	12%
Aetna	$521 - $1,479	14%
Security Hp Comm - All Other Plans	$1,479	40%
Quartz Comm - All Other Plans	$1,566	43%
Humana	$1,610	44%
Cigna	$1,688	46%
The Alliance - All Plans	$1,926	53%

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 $1,001.
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 Tomah Memorial 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.