CMS Price Transparency Data

Inguinal hernia repair

Facility: The Children's Mercy Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $834
Cash Discount Price: $937
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at The Children's Mercy Hospital is $834. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $937. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 0.23x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$937

Average discount available for prompt cash payment at this facility.

Insurance Median

$834

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: $937 (26%)

Insurance Median: $834 (23%)

Cash: $937 (26% of Medicare)

Ins. Median: $834 (23% 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
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%
Aetna	$823 - $957	22%
Multiplan	$823	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%

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 $937.
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 The Children's Mercy 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.