CMS Price Transparency Data

Inguinal hernia repair

Facility: Hospital for Special Surgery

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $12,245
Cash Discount Price: $11,623
vs. Medicare Baseline: 3.35x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Hospital for Special Surgery is $12,245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,623. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 3.35x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$11,623

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,245

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: $11,623 (318%)

Insurance Median: $12,245 (335%)

Cash: $11,623 (318% of Medicare)

Ins. Median: $12,245 (335% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 335% of the Medicare baseline (a markup of 235%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$70 - $12,543	2%
Nyship	$641	18%
Emblem	$1,038	28%
UnitedHealthcare	$1,040 - $14,759	28%
Cigna	$1,128 - $12,245	31%
Aetna	$1,176 - $12,511	32%
Horizon	$1,391	38%
Affinity By Molina Health Plan [1005]	$8,237	225%
Oxford [1096]	$9,451	258%
Emblem Health [1043]	$10,848 - $12,543	297%
Geha [1053]	$12,177	333%
Student Resources [1103]	$12,177	333%
Apwu [1016]	$12,245	335%
Nalc [1090]	$12,245	335%
Qualcare [1101]	$12,245	335%
Wellfleet [1361]	$12,245	335%
Christian Brothers [1034]	$12,511	342%
Meritain Health [1085]	$12,511	342%
Nippon Life [1092]	$12,511	342%
Webtpa [1356]	$12,511	342%
Connecticare [1039]	$12,543	343%
Harvard Pilgrim [1057]	$14,759	403%

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 $11,623.
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 Hospital for Special Surgery 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.