Inguinal hernia repair
Facility: Children'S Mercy South
Billing Code: 49505 (CPT)
- CPT Billing Code: 49505
- Insurance Median: $834
- Cash Discount Price: $937
- vs. Medicare Baseline: 0.23x 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.
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 |
|---|---|---|
| UnitedHealthcare | $431 - $1,001 | 12% |
| Healthy Blue | $460 - $745 | 13% |
| Medicaid / KanCare | $464 | 13% |
| Wppa Providrs Care | $608 | 17% |
| Blue Cross Blue Shield | $644 - $834 | 18% |
| Quiktrip | $645 | 18% |
| Healthlink | $646 | 18% |
| Health Midwest Comprehensive Care | $703 | 19% |
| Home State Health | $745 | 20% |
| American Healthcare Alliance | $748 | 20% |
| Multiplan | $823 | 22% |
| Aetna | $823 - $957 | 22% |
| Medica | $910 - $1,365 | 25% |
| Humana | $969 | 26% |
| Wellfit/Centrus | $972 | 27% |
| Orscheln | $979 | 27% |
| Cigna | $994 | 27% |
| Nebraska Furniture Mart | $996 | 27% |
| Centivo | $1,001 | 27% |
| Coventry Health Care Of Kansas | $1,040 | 28% |
| Mercy Health | $1,140 - $1,710 | 31% |
| Coxhealth Network | $1,155 - $1,733 | 32% |
| National Preferred Provider Network | $1,374 - $2,061 | 38% |
Consumer Guidance & Cost Commentary
For the inguinal hernia repair procedure (CPT 49505) at Children's Mercy South in Overland Park, KS, the facility's cash median price is $937, which is significantly lower than the gross charge of $1,952. While the facility's negotiated rates for in-network payers range from a low of $431 to a high of $1,710, these amounts often exceed the cash price. For patients with high-deductible plans, paying the cash median of $937 upfront can be more cost-effective than relying on insurance, as the insurer's negotiated rate may result in a higher out-of-pocket expense if the patient has not yet met their deductible. It is important to note that the facility offers voluntary non-profit status and is located in a rural area, which may influence pricing structures compared to urban centers.
When evaluating the cost relative to broader benchmarks, the facility's cash rate of $937 is notably lower than the Medicare amount of $3,657.95, suggesting a markup that is well below the typical commercial range of 200% to 300% of Medicare. However, patients should be aware that the facility's gross charges are substantially higher than the state average for this procedure, meaning that even with insurance, the final bill could be inflated if the facility does not apply its prompt-pay discounts. To secure the best possible rate, patients should explicitly request a self-pay classification and prompt-pay discount before scheduling, as waiting until after receiving a post-insurance bill may result in losing these upfront fee reductions. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non