CMS Price Transparency Data

Inguinal hernia repair

Facility: Stoughton Hospital

Billing Code: 49505 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$1,424

about 0.4× the $3,658 Medicare rate · typically $546–$6,275

modeled estimate · not a bill or quote

What this hospital charges insurers

$565

Below the fair price — a good deal

about $859 under the fair price · 0.2× Medicare

Medicare pays $3,658 Fair price $1,424 This hospital $565 Cash price $1,057 Hospital's list price $1,923

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 4 charge more and 4 charge less, among the 9 WI hospitals compared.

Cheapest $453 Priciest $1,917

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Inguinal hernia repair is about $1,424 (about 0.4× the $3,658 Medicare rate). Stoughton Hospital charges insurers about $565, or about $1,057 in cash — below the fair price — a good deal. Located in Stoughton, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$453 - $1,538	12%
Blue Cross Blue Shieldmajor	$835	23%
Aetnamajor	$453 - $1,500	12%
Cignamajor	$1,538	42%
Humanamajor	$565 - $1,730	15%
Dean Health Plan	$453 - $827	12%
GEHA	$1,442	39%
Health Net	$385	11%
Quartz	$453 - $1,062	12%
+ 2 smaller / regional plans	$1,676 - $7,133

Government programs also on file: Medicaid, Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,057), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 49505.

Insurance Before you use insurance

Call your insurance company to confirm Stoughton Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 49505.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Stoughton Hospital

Compare: Inguinal hernia repair at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.