CMS Price Transparency Data

Inguinal hernia repair

Facility: Stoughton Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $835
Cash Discount Price: $1,057
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Stoughton Hospital is $835. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,057. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.23x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$1,057

Average discount available for prompt cash payment at this facility.

Insurance Median

$835

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: $1,057 (29%)

Insurance Median: $835 (23%)

Cash: $1,057 (29% of Medicare)

Ins. Median: $835 (23% 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
Healthnet Mcr Adv - All Plans	$385	11%
Tricare	$385	11%
Aetna	$453 - $1,500	12%
Dean Health Insurance Med Adv	$453	12%
Quartz Mcr Adv	$453	12%
Security Health/First Health - All Plans	$453	12%
UnitedHealthcare	$453 - $1,538	12%
Humana	$565 - $1,730	15%
Dean Health Insurance Comm - All Other Plans	$827	23%
Dean Health Insurance Epo	$827	23%
Blue Cross Blue Shield	$835	23%
Quartz Health Solutions - All Other Lans	$1,062	29%
Medicaid / KanCare	$1,097	30%
Geha - All Plans	$1,442	39%
Cigna	$1,538	42%
Wisconsin Ppo Ppa Direct - All Plans	$1,538	42%
Alliance - All Plans	$1,676	46%
Wps - All Plans	$7,133	195%

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 $1,057.
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 Stoughton 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.