CMS Price Transparency Data

Inguinal hernia repair

Facility: Harlem Hospital Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 49505
  • Insurance Median: $3,397
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.93x Medicare
The contracted insurance negotiated median rate for a Inguinal hernia repair at Harlem Hospital Center is $3,397. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.93x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,397

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%)
Insurance Median: $3,397 (93%)
Ins. Median: $3,397 (93% 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.

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
Aetna $257 - $3,076 7%
Emblem $319 - $6,264 9%
Magnacare $320 - $8,199 9%
Oxford $362 - $3,773 10%
United $434 - $4,025 12%
Healthfirst $485 - $5,624 13%
Oscar $614 - $4,454 17%
Wellcare $655 18%
Fidelis $874 - $5,930 24%
Metroplus $1,200 - $5,624 33%
Amidacare $2,499 68%
Blue Cross Blue Shield $2,499 - $8,746 68%
Carelon $2,499 - $7,106 68%
Senior Whole Health $2,499 68%
United Behavioral Health $2,499 - $2,749 68%
Affinity $2,549 - $5,624 70%
Carelon (Amida Care) $2,549 70%
Vnsny $2,549 - $4,176 70%
Local 1199 $3,284 - $9,292 90%
Elderplan $4,176 114%
Vaccn $4,176 114%
Cigna $4,285 117%
Centers Plan For Healthy Living $4,343 119%
Centerlight $5,466 149%
Multiplan $8,746 239%
Villagecare Max $9,292 254%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 506 Lenox Avenue, New York, NY 10037
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals