CMS Price Transparency Data

Inguinal hernia repair

Facility: Kaleida Health

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $4,497
Cash Discount Price: $1,601
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Kaleida Health is $4,497. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,601. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.23x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$1,601

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,497

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: $1,601 (44%)

Insurance Median: $4,497 (123%)

Cash: $1,601 (44% of Medicare)

Ins. Median: $4,497 (123% 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
Ghi/Emblem Health	$586 - $6,034	16%
Ghi/Emblem Health - Wchob	$586 - $733	16%
Aetna	$611 - $4,738	17%
Magnacare	$611 - $4,229	17%
Magnacare - Wchob	$611 - $4,229	17%
Univera	$761 - $6,228	21%
Univera - Wchob	$761 - $6,057	21%
Independent Health Association	$2,600 - $7,073	71%
Independent Health Association - Wchob	$2,698 - $7,247	74%
Blue Cross Blue Shield	$3,048 - $16,678	83%
Tricare	$4,246	116%
Wellcare	$4,648	127%
Fidelis	$4,827	132%
UnitedHealthcare	$4,849	133%
Cigna	$5,229 - $6,346	143%

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 $1,601.
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 Kaleida Health 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.