CMS Price Transparency Data

Inguinal hernia repair

Facility: North Texas Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,296
Cash Discount Price: $2,582
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at North Texas Medical Center is $3,296. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,582. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.90x the Medicare baseline. Located in 1900 Hospital Blvd, Gainesville, TX.

Cash / Self-Pay

$2,582

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,296

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: $2,582 (71%)

Insurance Median: $3,296 (90%)

Cash: $2,582 (71% of Medicare)

Ins. Median: $3,296 (90% 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
Cigna	$550 - $7,712	15%
Blue Cross Blue Shield	$688 - $9,640	19%
First Health	$825 - $11,567	23%
Healthcare Highways	$825 - $11,567	23%
Aetna	$853 - $11,953	23%
Multiplan	$962 - $13,495	26%
Provider Select	$1,169 - $16,387	32%
Prime Health	$1,238 - $17,351	34%
UnitedHealthcare	$1,265 - $17,737	35%
90 Degree Benefits	$3,296	90%
Humana	$3,296	90%
Molina	$3,296 - $3,626	90%
Prominence Health	$3,296 - $3,461	90%
Superior	$3,296 - $3,626	90%
Wellmed	$3,296	90%
Wellpoint	$3,296	90%
Providers Partners Health Plan	$3,461	95%

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 $2,582.
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 North Texas 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.