CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: HCA Florida Citrus Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $80
Cash Discount Price: $416
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at HCA Florida Citrus Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $416. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.36x the Medicare baseline. Located in 502 W Highland Blvd, Inverness, FL.

Cash / Self-Pay

$416

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$223.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $223.72 (100%)

Cash / Self-Pay: $416 (186%)

Insurance Median: $80 (36%)

Cash: $416 (186% of Medicare)

Ins. Median: $80 (36% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $223.72 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
Access 2 Healthcare Physicians Freedom Optimum Group Members	$17 - $23	8%
Access 2 Healthcare Physicians Freedom Health	$21 - $29	9%
Access 2 Healthcare Physicians Optimum	$21 - $29	9%
Freedom Health Care	$23 - $31	10%
Optimum Healthcare	$23 - $31	10%
Avmed	$28 - $120	13%
Blue Cross Blue Shield	$28 - $97	13%
Truli	$28 - $59	13%
Simply Healthcare	$45 - $61	20%
Aetna	$46 - $144	21%
Oscar	$53 - $72	24%
United	$58 - $216	26%
Cigna	$61 - $84	27%
Molina	$67 - $130	30%
Evolutions Healthcare Systems	$81 - $442	36%
Sunshine State Health Plan	$90 - $122	40%
Corvel Corporation	$91	41%
Rockport Healthcare Group	$91	41%
Prime Health	$93	42%
Humana	$99 - $134	44%
Beacon Health Options	$176 - $240	79%
Plotkin Health	$176 - $240	79%
Prime Health Sheriff	$176 - $240	79%
Multiplan	$265 - $408	118%
Evernorth	$282 - $384	126%

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 $416.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 94640.

Insurance In-Network Protection Plan

Contact your insurance company to confirm HCA Florida Citrus Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 94640.
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.