CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sacred Heart Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $209
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sacred Heart Hospital is $209. 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 $223.72, this hospital’s rate is 0.93x the Medicare baseline. Located in 5151 N 9Th Ave, Pensacola, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$209

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%)

Insurance Median: $209 (93%)

Ins. Median: $209 (93% 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
Blue Mcr Replacement	$204	91%
Facility Billing - Op	$204	91%
Medicare (plans)	$204	91%
Wellcare	$204	91%
Healthspring Mcr Replacement	$206 - $208	92%
UnitedHealthcare	$206	92%
Aetna	$210	94%
Humana	$210	94%
Smarthealth	$286	128%
Oscar Health Plan	$327	146%
Ambetter / Centene	$337	151%
Occunet	$378 - $459	169%

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: 94640.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sacred Heart 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.