CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: North Shore Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $207
  • Cash Discount Price: $966
  • vs. Medicare Baseline: 0.93x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at North Shore Medical Center is $207. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $966. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.93x the Medicare baseline. Located in 1100 Nw 95Th St, Miami, FL.
Cash / Self-Pay
$966

Average discount available for prompt cash payment at this facility.

Insurance Median
$207

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: $966 (432%)
Insurance Median: $207 (93%)
Cash: $966 (432% of Medicare)
Ins. Median: $207 (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.

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
Healthsun Health Plans $9 - $207 4%
Self Pay/Uninsured $10 - $246 4%
Employer Direct Healthcare $11 - $200 5%
Aetna $29 - $695 13%
Humana $37 - $385 17%
Medicaid / KanCare $37 - $966 17%
UnitedHealthcare $38 - $631 17%
Oscar Health Plan Hix $114 51%
Bc/Bs Of Fl Network Blue $138 62%
Veterans Administration Mill Bill $138 62%
Bc/Bs Myblue Hmo Hix $147 66%
Bc/Bs Of Fl Blue Select Exchange Non Par $147 66%
Bc/Bs Of Fl Health Options Hmo $147 66%
Bc/Bs Of Fl Simplyblue $157 70%
Imagine Health $161 72%
Bc/Bs Of Fl Ppo $166 74%
Cigna $168 - $483 75%
Medicare (plans) $177 - $966 79%
Leon Health Inc $196 88%
Devoted Health $197 88%
Tricare $198 89%
Hospice Other $200 89%
Veterans Administration Vaccn $200 89%
Avmed Broad Network $203 91%
Longevity Health Plan $210 94%
Florida Pace Centers $236 105%
Bright Health Management Commercial $240 107%
Centurion Prison $246 110%
Avmed Exchange $350 156%
Ambetter / Centene $370 165%
Molina Marketplace Program Exchange $381 170%
Auto Insurance $400 179%
Avmed Select Network $410 183%
Amerihealth Caritas Next Exchange $430 192%
Bc/Bs Of Fl Phs $501 224%
Magellan Behavioral Health $579 259%
Dimensions International $628 281%
First Health $657 294%
Dimension Health Ppo $724 324%
Dimension Health Wc $724 324%
Workers Compensation $724 324%
Beacon Health Strategies Commercial $966 432%
Commercial Non-Contracted $966 432%
Self Pay - Mcd Pending 100 Percent $966 432%
Single Case Agreement $966 432%
United Behavioral Health Psych $966 432%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1100 Nw 95Th St, Miami, FL 33150
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals