CMS Price Transparency Data
Inguinal hernia repair
Facility: St Francis Hospital - the Heart Center
Billing Code: 49505 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 49505
- Insurance Median: $4,354
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.19x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at St Francis Hospital - the Heart Center is $4,354. 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 1.19x the Medicare baseline. Located in 100 Port Washington Boulevard, Roslyn, NY.
Cash / Self-Pay
Unavailable
Average discount available for prompt cash payment at this facility.
Insurance Median
$4,354
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: $4,354 (119%)
Ins. Median: $4,354 (119% 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.
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 |
|---|---|---|
| Zadroga | $1,193 | 33% |
| Brighton | $2,102 - $5,879 | 57% |
| Affinity Health Plan | $2,508 - $5,643 | 69% |
| Centerlight Healthcare | $2,508 - $4,176 | 69% |
| Elderplan Inc. | $2,508 - $4,176 | 69% |
| Emblem Health | $2,508 - $5,721 | 69% |
| Fidelis Care New York | $2,508 - $5,643 | 69% |
| Health First | $2,508 - $9,396 | 69% |
| Health Plus | $2,508 - $5,643 | 69% |
| Independent Health | $2,508 - $4,176 | 69% |
| Medicaid / KanCare | $2,508 | 69% |
| Mvp Health Plans | $2,508 - $5,190 | 69% |
| Senior Whole Health | $2,508 - $4,176 | 69% |
| UnitedHealthcare | $2,508 - $6,542 | 69% |
| Centivo | $3,913 - $5,190 | 107% |
| Local 1199 | $3,945 | 108% |
| Blue Cross Blue Shield | $4,093 - $6,542 | 112% |
| Aetna | $4,176 - $5,919 | 114% |
| Centers Plan For Healthy Living | $4,176 | 114% |
| Healthspring | $4,176 | 114% |
| Liberty Health | $4,176 | 114% |
| Longevity Health Plan | $4,176 | 114% |
| Medicare (plans) | $4,176 - $4,385 | 114% |
| Orthonet - Uniformed Services Family Health Plan | $4,176 | 114% |
| Pmc | $4,176 | 114% |
| Tricare | $4,176 | 114% |
| Universal Healthcare | $4,176 | 114% |
| Us Family Health Plan | $4,176 | 114% |
| Veterans Affairs | $4,176 | 114% |
| Humana | $4,260 | 116% |
| Agewell New York | $4,322 | 118% |
| Partners Health Plan | $4,385 | 120% |
| Wellcare Health Plan Inc | $4,594 | 126% |
| Oscar Health | $4,688 | 128% |
| Apwu | $5,190 | 142% |
| Cigna | $5,190 - $8,003 | 142% |
| Daniel H Cook | $5,190 | 142% |
| Nalc | $5,190 | 142% |
| Samba | $5,190 | 142% |
| American Plan Administrators | $5,721 | 156% |
| Amerihealth Administrators | $5,721 | 156% |
| Benefit Services | $5,721 | 156% |
| Ghi Cbp Ny City Employee Alternate | $5,721 | 156% |
| International Benefit Administrator | $5,721 | 156% |
| Ultra Benefits Inc. | $5,721 | 156% |
| Surest | $5,768 | 158% |
| Mail Handlers Benefit Plan | $5,919 | 162% |
| Meritain Health | $5,919 | 162% |
| Nippon Life Insurance Company Of America | $5,919 | 162% |
| Salvation Army | $5,919 | 162% |
| Self Pay | $6,542 | 179% |
| Allied Wellfare Fund | $8,003 | 219% |
| American Group Administrators | $8,003 | 219% |
| Bakery & Confectionery Union | $8,003 | 219% |
| Comprehensive Benefits Consultant | $8,003 | 219% |
| Guardian Life Insurance Company Of America | $8,003 | 219% |
| Maloney And Assoc | $8,003 | 219% |
| Multiplan | $8,003 | 219% |
| Performax | $8,003 | 219% |
| Phcs | $8,003 | 219% |
| Pomco | $8,003 | 219% |
| Tpa Inc | $8,003 | 219% |
| Unicare | $8,003 | 219% |
| United Employees Health Plan | $8,003 | 219% |
| Coventry | $8,460 - $9,489 | 231% |
| Galaxy | $10,290 | 281% |
| Three Rivers Provider Network | $10,290 | 281% |
| Aither Health | $11,433 | 313% |
| Alpha Care | $11,433 | 313% |
| Dentaquest | $11,433 | 313% |