CMS Price Transparency Data

Inguinal hernia repair

Facility: Glens Falls Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $561
Cash Discount Price: $2,000
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Glens Falls Hospital is $561. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,000. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.15x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$2,000

Average discount available for prompt cash payment at this facility.

Insurance Median

$561

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: $2,000 (55%)

Insurance Median: $561 (15%)

Cash: $2,000 (55% of Medicare)

Ins. Median: $561 (15% 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
Medicaid / KanCare	$234 - $492	6%
Cdphp	$332 - $6,880	9%
Medicare (plans)	$366 - $488	10%
UnitedHealthcare	$366 - $6,054	10%
Emblem Health Ghi	$415 - $488	11%
Tricare	$415 - $488	11%
Blue Cross Blue Shield	$442 - $6,259	12%
Mvp	$464 - $5,225	13%
Aetna	$488 - $4,218	13%
Fidelis	$488 - $5,598	13%
Blue Shield Highmark	$514 - $577	14%
Blue Shield	$659 - $1,430	18%
Cigna	$725 - $877	20%
Empire Plan Nyship	$3,396	93%
Hamaspik	$3,396	93%
Nascentia Health Options	$3,396	93%
Magnacare	$3,919	107%
Emblem	$4,180	114%
Multiplan	$4,441	121%
Mvp Commercial	$5,280 - $6,244	144%

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 $2,000.
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 Glens Falls 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.