CMS Price Transparency Data

Inguinal hernia repair

Facility: Maimonides Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $635
Cash Discount Price: $1,575
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Maimonides Medical Center is $635. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,575. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.17x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$1,575

Average discount available for prompt cash payment at this facility.

Insurance Median

$635

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: $1,575 (43%)

Insurance Median: $635 (17%)

Cash: $1,575 (43% of Medicare)

Ins. Median: $635 (17% 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	$78 - $7,047	2%
UnitedHealthcare	$202 - $6,254	6%
Emblem Health - Hip	$234 - $1,115	6%
Healthfirst	$393 - $4,380	11%
United Community Plan	$404 - $4,916	11%
Fidelis	$453 - $612	12%
Oxford Health Plan	$499 - $6,254	14%
Aetna	$505 - $4,469	14%
Local 1199	$513 - $3,465	14%
Metroplus	$595 - $5,363	16%
Elderplan	$605	17%
Emblem Health - Hip Vip	$617	17%
Molina	$630	17%
Cigna	$762 - $952	21%
Oxford Liberty	$849 - $6,254	23%
Emblem Health - Ghi	$1,083 - $13,587	30%
Magnacare	$7,738	212%
Centivo	$9,010	246%

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 $1,575.
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 Maimonides Medical Center 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.