Inguinal hernia repair
Facility: Kansas City Orthopaedic Institute
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $7,983
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.18x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 218% of the Medicare baseline (a markup of 118%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $3,070 | 84% |
| UnitedHealthcare | $3,070 | 84% |
| Cigna | $3,320 | 91% |
| Blue Cross Blue Shield | $7,983 | 218% |
Consumer Guidance & Cost Commentary
For the Inguinal hernia repair procedure at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rate of $7,983 is significantly higher than the state average, which sits at 2.2 times the Medicare benchmark of $3,657.95. While commercial payers like Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Aetna have all contracted with the facility at this specific rate, patients with high-deductible plans may find that paying cash directly is more cost-effective. Since the cash price is not listed in the current data, it is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if settled upfront.
It is important to understand that the $7,983 negotiated rate represents the maximum amount an in-network insurer will pay, which often exceeds the true cost of care due to administrative overhead and contract dynamics. If you are billed a higher amount than this negotiated rate, it may indicate balance billing for out-of-network services, though the No Surprises Act generally protects you from such charges for emergency care and non-emergency services at in-network facilities. To ensure you are receiving the most accurate pricing, always request a full itemized bill before paying, as summary invoices can obscure unbundled charges or services not rendered. Disputing any discrepancies in writing with the billing supervisor is the most effective way to verify that your charges align with the facility's contracted rates and federal protections.