CMS Price Transparency Data

Inguinal hernia repair

Facility: Penn State Health Lancaster Medical Center

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,601
Cash Discount Price: $6,650
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Penn State Health Lancaster Medical Center is $3,601. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,650. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.98x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$6,650

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,601

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: $6,650 (182%)

Insurance Median: $3,601 (98%)

Cash: $6,650 (182% of Medicare)

Ins. Median: $3,601 (98% 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
[Amerihealth Caritas]	$2,986 - $3,513	82%
[Highmark Wholecare]	$2,986 - $3,513	82%
[Geisinger]	$3,162 - $15,287	86%
[Health Partners Plans]	$3,267 - $3,584	89%
[Pa Health & Wellness]	$3,285 - $3,619	90%
[Highmark]	$3,478 - $15,355	95%
UnitedHealthcare	$3,513 - $14,360	96%
[Cbc]	$3,513 - $11,543	96%
Aetna	$3,548 - $13,784	97%
Humana	$3,548	97%
[Healthspring]	$3,548	97%
[Upmc]	$3,584 - $16,947	98%
[Point Comfort Underwriters]	$4,392	120%
[Highmark Choice Blue]	$12,284	336%
[Highmark Aca]	$12,898	353%
Cigna	$14,073	385%
[First Health]	$18,351	502%
[Multiplan]	$18,351	502%

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 $6,650.
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 Penn State Health Lancaster Medical Center 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.