CMS Price Transparency Data

Inguinal hernia repair

Facility: St David's South Austin Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $5,019
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at St David's South Austin Medical Center is $5,019. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.37x the Medicare baseline. Located in 901 West Ben White Blvd, Austin, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,019

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%)

Insurance Median: $5,019 (137%)

Ins. Median: $5,019 (137% 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
Amerigroup	$289	8%
St David’S Hospice	$1,152	31%
Blue Cross Blue Shield	$1,209 - $8,053	33%
United	$1,236 - $11,764	34%
Molina Healthcare	$1,267	35%
Humana	$1,439	39%
Sendero	$1,439	39%
Aetna	$1,612 - $5,457	44%
Superior Health Plan	$2,323	64%
Cigna	$4,704 - $6,004	129%
Nomi Health	$5,054 - $5,320	138%
Evry Health	$5,499	150%
Moda	$5,502	150%
Curative Administrators	$5,849	160%
Oscar	$5,938 - $7,019	162%
Healthcare Highways	$6,162 - $6,287	168%
Harbor Health Team	$6,450	176%
Moda Health	$6,746 - $6,879	184%

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 $X.
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 St David's South Austin 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.