CMS Price Transparency Data

Inguinal hernia repair

Facility: Kings County Hospital Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $2,554
Cash Discount Price: $3,960
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Kings County Hospital Center is $2,554. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,960. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.70x the Medicare baseline. Located in 451 Clarkson Avenue, Brooklyn, NY.

Cash / Self-Pay

$3,960

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,554

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: $3,960 (108%)

Insurance Median: $2,554 (70%)

Cash: $3,960 (108% of Medicare)

Ins. Median: $2,554 (70% 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
Healthfirst	$315 - $5,633	9%
Local 1199	$513 - $3,284	14%
Affinity	$554 - $5,633	15%
Aetna	$617 - $3,076	17%
Blue Cross Blue Shield	$630 - $5,633	17%
Centerlight	$630 - $6,450	17%
Elderplan	$630 - $4,176	17%
Fidelis	$630 - $5,930	17%
Wellcare	$639 - $680	17%
Centers Plan For Healthy Living	$655 - $4,343	18%
Hamaspik	$661	18%
Oscar	$787 - $4,454	22%
Metroplus	$1,200 - $5,633	33%
Amidacare	$2,504	68%
Carelon	$2,504 - $8,385	68%
Senior Whole Health	$2,504	68%
United	$2,504 - $4,660	68%
United Behavioral Health	$2,504 - $2,754	68%
Carelon (Amida Care)	$2,554	70%
Vnsny	$2,554 - $4,176	70%
Oxford	$3,326 - $3,773	91%
Emblem	$3,755 - $5,220	103%
Vaccn	$4,176	114%
Cigna	$4,285	117%
Magnacare	$9,675	264%
Multiplan	$10,320	282%
Villagecare Max	$10,965	300%

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 $3,960.
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 Kings County Hospital 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.