CMS Price Transparency Data

Inguinal hernia repair

Facility: St James Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $504
Cash Discount Price: $1,047
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at St James Hospital is $504. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,047. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.14x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$1,047

Average discount available for prompt cash payment at this facility.

Insurance Median

$504

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: $1,047 (29%)

Insurance Median: $504 (14%)

Cash: $1,047 (29% of Medicare)

Ins. Median: $504 (14% 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	$194 - $10,701	5%
Medicaid / KanCare	$199 - $492	5%
Fidelis 5155	$379 - $445	10%
Aetna	$424 - $4,787	12%
Excellus 2201	$424 - $499	12%
Medicare (plans)	$424 - $5,265	12%
Mvp 2900	$449 - $10,392	12%
UnitedHealthcare	$449 - $4,787	12%
Cigna	$620 - $10,765	17%
Capital District Physicians Health Plan (Cdphp) 5149	$1,274	35%
Humana	$4,787	131%
Empire Plan 5179	$10,100	276%

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 $1,047.
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 James Hospital 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.