CMS Price Transparency Data

Inguinal hernia repair

Facility: Strong Memorial Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $879
Cash Discount Price: $4,250
vs. Medicare Baseline: 0.24x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Strong Memorial Hospital is $879. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,250. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.24x the Medicare baseline. Located in 601 Elmwood Ave, Rochester, NY.

Cash / Self-Pay

$4,250

Average discount available for prompt cash payment at this facility.

Insurance Median

$879

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: $4,250 (116%)

Insurance Median: $879 (24%)

Cash: $4,250 (116% of Medicare)

Ins. Median: $879 (24% 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	$199 - $562	5%
UnitedHealthcare	$351 - $4,616	10%
Aetna	$415 - $4,762	11%
Excellus Bc/Bs [2201]	$415 - $904	11%
Medicare (plans)	$415 - $4,967	11%
Elderplan [1316]	$488	13%
Icircle [1728]	$488	13%
Martins Point [1205]	$488 - $4,469	13%
Nascentia [1729]	$488	13%
Humana	$493 - $4,879	13%
Highmark Bc/Bs Of Western Ny [5143]	$522 - $614	14%
Fidelis [5155]	$591 - $659	16%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$642 - $1,682	18%
Independent Health [5156]	$765 - $925	21%
Mvp [2900]	$890 - $8,853	24%
Cigna	$1,163 - $8,853	32%
Capital District Physicians Health Plan (Cdphp) [5149]	$1,274 - $1,704	35%
Blue Cross Blue Shield	$4,469 - $7,798	122%

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 $4,250.
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 Strong Memorial 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.