CMS Price Transparency Data

Inguinal hernia repair

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $513
Cash Discount Price: $1,574
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at The University of Vermont Health Network-Alice Hy is $513. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,574. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.14x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$1,574

Average discount available for prompt cash payment at this facility.

Insurance Median

$513

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: $1,574 (43%)

Insurance Median: $513 (14%)

Cash: $1,574 (43% of Medicare)

Ins. Median: $513 (14% 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
Capital District Physicians' Health Plan	$332 - $795	9%
UnitedHealthcare	$342 - $9,020	9%
Blue Cross Blue Shield	$403 - $11,420	11%
Fidelis Care	$415 - $562	11%
Humana	$415	11%
Mvp	$415 - $1,122	11%
Aetna	$488 - $751	13%
Martins Point	$488	13%
Veterans Affairs Community Care Network	$488	13%
Choicecare	$506 - $657	14%
St. Regis	$1,022	28%
Magnacare	$1,259	34%
Highmark Blueshield	$1,543	42%

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 $1,574.
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 The University of Vermont Health Network-Alice Hy 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.