CMS Price Transparency Data

Inguinal hernia repair

Facility: Lower Bucks Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,649
Cash Discount Price: $3,522
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Lower Bucks Hospital is $3,649. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,522. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 1.00x the Medicare baseline. Located in 501 Bath Road, Bristol, PA.

Cash / Self-Pay

$3,522

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,649

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: $3,522 (96%)

Insurance Median: $3,649 (100%)

Cash: $3,522 (96% of Medicare)

Ins. Median: $3,649 (100% 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	$806	22%
Health Partners Plan	$1,582 - $5,283	43%
UnitedHealthcare	$2,040 - $6,791	56%
Humana	$2,818	77%
Blue Cross Blue Shield	$3,453 - $4,358	94%
Medicare (plans)	$3,522 - $3,698	96%
Pa Health & Wellness	$3,522 - $4,227	96%
Tricare	$3,522	96%
Provider Patners Health Plan	$3,628	99%
Keystone	$3,634 - $3,663	99%
Spartan Plan Pa	$3,698	101%
Auto Insurance	$3,875	106%
Worker Compensation	$3,980	109%
Employer Direct Healthcare	$4,931	135%
Cigna	$6,791	186%
Highmark	$6,791	186%

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 $3,522.
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 Lower Bucks 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.