CMS Price Transparency Data

Inguinal hernia repair

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $4,833
Cash Discount Price: $6,211
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Baylor Scott & White Medical Center - Marble Falls is $4,833. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,211. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.32x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$6,211

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,833

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: $6,211 (170%)

Insurance Median: $4,833 (132%)

Cash: $6,211 (170% of Medicare)

Ins. Median: $4,833 (132% 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
Blue Cross Blue Shield	$66 - $5,597	2%
Superior Health Plan	$1,152 - $3,051	31%
Baylor Scott & White Health Plan	$2,898 - $5,034	79%
Humana	$3,051 - $7,246	83%
Triwest	$3,051	83%
Corvel	$3,196	87%
Prime Health Services	$3,196	87%
American Health Plan	$3,203	88%
Healthspring	$3,203	88%
Procare Advantage	$3,203	88%
UnitedHealthcare	$3,508 - $5,103	96%
Sedgwick	$4,561	125%
Cigna	$5,132 - $6,242	140%
Midcoast	$5,693	156%
Quiktrip	$5,693	156%
University Of Mary Hardin-Baylor	$6,004	164%
Independent Medical System	$6,211	170%
Curative	$6,728	184%
First Health	$7,246	198%
Healthsmart	$7,564 - $7,763	207%
Bluebell Creameries	$7,763	212%
Private Health Care System	$7,763	212%
Three Rivers	$9,316	255%
Aetna	$10,200	279%

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 $6,211.
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 Baylor Scott & White Medical Center - Marble Falls 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.