CMS Price Transparency Data

Inguinal hernia repair

Facility: HCA Florida Fort Walton-Destin Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $13,033
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.56x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at HCA Florida Fort Walton-Destin Hospital is $13,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,657.95, this hospital’s rate is 3.56x the Medicare baseline. Located in 1000 Mar-Walt Dr, Fort Walton Beach, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,033

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%)

Insurance Median: $13,033 (356%)

Ins. Median: $13,033 (356% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 356% of the Medicare baseline (a markup of 256%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Molina Healthcare	$3,950 - $6,243	108%
Simply	$3,950	108%
Corvel Corporation	$4,486 - $12,765	123%
Prime Health	$4,581 - $13,033	125%
Careworks (Rockport Community)	$4,722 - $13,436	129%
Sunshine State Health Plan	$6,673	182%
Avmed	$8,168 - $8,971	223%
Oscar	$8,959	245%
Simply Healthcare	$9,252	253%
United	$14,480	396%
Cigna	$17,004 - $40,673	465%
Blue Cross Blue Shield	$20,393 - $49,339	557%

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 $X.
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 HCA Florida Fort Walton-Destin 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.