CMS Price Transparency Data

Inguinal hernia repair

Facility: Adventist Health Lodi Memorial

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $568
Cash Discount Price: $55
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Adventist Health Lodi Memorial is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.16x the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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: $55 (2%)

Insurance Median: $568 (16%)

Cash: $55 (2% of Medicare)

Ins. Median: $568 (16% 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
Bc Mcal	$65	2%
Celtic Ins Company - All Plans	$65	2%
Kaiser Mcal	$65	2%
Medi-Cal	$65	2%
Hp Mcal Pro Fee	$72	2%
Healthnet Mcal	$78	2%
Hp Of San Joaquin Mcal	$78	2%
Alignment Health Plan (Ahp)-All Plans	$498	14%
Blue Shield Mcare Adv	$498	14%
Healthnet Mcare	$498	14%
Hp Of San Joaquin Mcr Adv	$498	14%
Humana	$498	14%
Knnex Health - All Plans	$498	14%
Tricare	$498	14%
UnitedHealthcare	$498 - $691	14%
Hp Healthy Kids Pro Fee	$523	14%
Ah Employee Health Plan - All Plans	$548	15%
Cigna	$589	16%
First Health- All Plans	$598	16%
Aetna	$637	17%
Beech Street- All Plans	$647	18%
Hp Of San Joaquin Ppo - All Other Plans	$647	18%
Multiplan- All Plans	$647	18%
Kaiser Commercial - All Other Plans	$672	18%
Kaiser Mcr Adv	$672	18%
Networks By Design- All Plans	$672	18%
Blue Shield Epn - All Other Plans	$706	19%
Western Growers- All Plans	$712	19%
Healthnet- All Other Plans	$726	20%
Blue Shield Non-Epn	$746	20%
Blue Cross Blue Shield	$882	24%

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 $55.
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 Adventist Health Lodi Memorial 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.