CMS Price Transparency Data

Inguinal hernia repair

Facility: Gulf Breeze Hospital

Billing Code: 49505 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 49505
Insurance Median: $3,551
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Inguinal hernia repair at Gulf Breeze Hospital is $3,551. 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 0.97x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,551

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: $3,551 (97%)

Ins. Median: $3,551 (97% 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
Aetna	$2,350 - $3,720	64%
Cha Health Plan	$2,350	64%
UnitedHealthcare	$2,350 - $3,560	64%
Humana	$2,468 - $3,613	67%
Sunshine Health	$2,468	67%
Wellcare	$2,468 - $3,720	67%
Fl Community Care Ltc	$2,515	69%
Simply Healthcare Healthy Kids	$2,703	74%
Medicare (plans)	$2,922	80%
Hospice Covenant	$3,542	97%
Wc Corvel	$3,993	109%
Fl Blue	$5,916	162%

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 Gulf Breeze 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.