CMS Price Transparency Data

Inguinal hernia repair

Facility: Providence St. Jude Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $8,753
Cash Discount Price: $2,166
vs. Medicare Baseline: 2.39x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Providence St. Jude Medical Center is $8,753. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,166. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 2.39x the Medicare baseline. Located in 101 E Valencia Mesa Drive, Fullerton, CA.

Cash / Self-Pay

$2,166

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,753

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: $2,166 (59%)

Insurance Median: $8,753 (239%)

Cash: $2,166 (59% of Medicare)

Ins. Median: $8,753 (239% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 239% of the Medicare baseline (a markup of 139%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Providence	$3,914	107%
Aetna	$4,605 - $11,564	126%
Blue Cross Blue Shield	$4,825 - $20,418	132%
Blue Shield	$7,920 - $10,887	217%
UnitedHealthcare	$8,335 - $8,987	228%
Healthnet	$8,519 - $9,990	233%

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 $2,166.
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 Providence St. Jude Medical Center 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.