CMS Price Transparency Data

Inguinal hernia repair

Facility: Queens Hospital Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $2,549
Cash Discount Price: $4,001
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Queens Hospital Center is $2,549. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,001. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.70x the Medicare baseline. Located in 82-68 164Th Street, Jamaica, NY.

Cash / Self-Pay

$4,001

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,549

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: $4,001 (109%)

Insurance Median: $2,549 (70%)

Cash: $4,001 (109% of Medicare)

Ins. Median: $2,549 (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	$300 - $5,623	8%
Local 1199	$513 - $3,284	14%
Affinity	$528 - $5,623	14%
Blue Cross Blue Shield	$600 - $5,623	16%
Centerlight	$600 - $6,450	16%
Elderplan	$600 - $4,176	16%
Fidelis	$600 - $5,930	16%
Wellcare	$609 - $648	17%
Aetna	$617 - $3,076	17%
Centers Plan For Healthy Living	$624 - $4,343	17%
Hamaspik	$630	17%
Oscar	$750 - $4,454	21%
Metroplus	$1,200 - $5,623	33%
Amidacare	$2,499	68%
Carelon	$2,499 - $8,385	68%
Senior Whole Health	$2,499	68%
United	$2,499 - $4,660	68%
United Behavioral Health	$2,499 - $2,749	68%
Carelon (Amida Care)	$2,549	70%
Vnsny	$2,549 - $4,176	70%
Oxford	$3,326 - $3,773	91%
Emblem	$3,749 - $5,220	102%
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 $4,001.
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 Queens 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.