CMS Price Transparency Data

Inguinal hernia repair

Facility: St Charles Hospital

Billing Code: 49505 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$3,046

about 0.8× the $3,658 Medicare rate · typically $1,369–$4,170

modeled estimate · not a bill or quote

What this hospital charges insurers

$4,176

Above the fair price

about $1,130 over the fair price · 1.1× Medicare

Medicare pays $3,658 Fair price $3,046 This hospital $4,176 Hospital's list price $11,433

How we calculate the fair BaseRate →

How this hospital compares to other NY hospitals

Highest price of the 9 NY hospitals we have prices for — worth calling around.

Cheapest $491 Priciest $4,176

Black dot = this hospital, among the 9 NY hospitals with a price for this procedure. Full list below.

A fair price for a Inguinal hernia repair is about $3,046 (about 0.8× the $3,658 Medicare rate). St Charles Hospital charges insurers about $4,176 — above the fair price. Located in Port Jefferson, NY.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $3,046. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$2,508 - $7,431	69%
Blue Cross Blue Shieldmajor	$3,136 - $4,176	86%
Aetnamajor	$4,176 - $9,718	114%
Cignamajor	$4,871 - $7,431	133%
Humanamajor	$4,260	116%
AmeriHealth	$5,183	142%
Cigna HealthSpring	$4,176	114%
Fidelis Care	$2,508 - $5,643	69%
Independent Health	$2,508 - $4,176	69%
MVP Health Care	$2,508 - $4,871	69%
Oscar Health	$4,688	128%
UniCare	$7,431	203%
WellCare	$4,594	126%
+ 44 smaller / regional plans	$1,193 - $11,433

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 7 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 49505.

Insurance Before you use insurance

Call your insurance company to confirm St Charles Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 49505.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Charles Hospital

Compare: Inguinal hernia repair at other NY hospitals

Insurance negotiated median for the same procedure, sorted lowest first.