CMS Price Transparency Data

Inguinal hernia repair

Facility: Saratoga Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $514
Cash Discount Price: $788
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Saratoga Hospital is $514. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $788. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.14x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$788

Average discount available for prompt cash payment at this facility.

Insurance Median

$514

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: $788 (22%)

Insurance Median: $514 (14%)

Cash: $788 (22% of Medicare)

Ins. Median: $514 (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
Medicaid / KanCare	$234 - $492	6%
Cdphp	$332 - $5,585	9%
Fidelis	$366 - $5,585	10%
Medicare (plans)	$366 - $488	10%
Blue Cross Blue Shield	$403 - $6,598	11%
Tricare	$415 - $488	11%
Hamaspik	$457 - $5,834	12%
Mvp	$464 - $877	13%
UnitedHealthcare	$485 - $2,482	13%
Emblem Health Ghi	$488 - $537	13%
Aetna	$498 - $556	14%
Blue Shield Highmark	$514 - $589	14%
Cigna	$725 - $877	20%
Mvp Essential Plan	$2,482 - $4,965	68%
Mvp Govt Programs	$2,482	68%
Emblem	$4,176	114%

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 $788.
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 Saratoga 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.