CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Hialeah Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $193
  • Cash Discount Price: $247
  • vs. Medicare Baseline: 0.86x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hialeah Hospital is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $247. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.86x the Medicare baseline. Located in 651 E 25Th St, Hialeah, FL.
Cash / Self-Pay
$247

Average discount available for prompt cash payment at this facility.

Insurance Median
$193

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: $247 (110%)
Insurance Median: $193 (86%)
Cash: $247 (110% of Medicare)
Ins. Median: $193 (86% 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
Aetna $7 - $197 3%
Healthsun Health Plans $9 - $207 4%
Self Pay/Uninsured $10 - $246 4%
Employer Direct Healthcare $11 - $200 5%
Humana $37 - $193 17%
Medicaid / KanCare $37 - $39 17%
Bc/Bs Myblue Hmo Hix $38 17%
Bc/Bs Of Fl Health Options Hmo $38 17%
Bc/Bs Of Fl Miami Dade Blue Select $38 17%
Bc/Bs Of Fl Network Blue $38 17%
Bc/Bs Of Fl Simplyblue $38 17%
UnitedHealthcare $38 - $613 17%
Bc/Bs Of Fl Blue Select Exchange Non Par $40 18%
Bc/Bs Of Fl Ppo $42 19%
Cigna $43 - $207 19%
Avmed Broad Network $52 23%
Oscar Health Plan Hix $114 51%
Bc/Bs Of Fl Phs $128 57%
Veterans Administration Mill Bill $138 62%
Dimensions International $161 72%
Imagine Health $161 72%
First Health $168 75%
Medicare (plans) $177 - $430 79%
Dimension Health Ppo $186 83%
Dimension Health Wc $186 83%
Workers Compensation $186 83%
Leon Health Inc $196 88%
Devoted Health $197 88%
Tricare $198 89%
Bristol Hospice- Miami Dade Llc $200 89%
Catholic Hospice $200 89%
Comprehensive Home Health Care Dba Opuscare Of South Florida $200 89%
Hcr Manor Care Services Of Fl $200 89%
Hospice Other $200 89%
Odyssey Healthcare Of Marion County Dba Kindred Hospice $200 89%
Seasons Hospice And Pallative Care Of Southern Florida Inc $200 89%
Veterans Administration Vaccn $200 89%
Vitas Healthcare Hospice Corporation Of Fl $200 89%
Vitas Hospice Unit Agreement $200 89%
Longevity Health Plan $209 93%
Florida Pace Centers $236 105%
Bright Health Management Commercial $240 107%
Commercial Non-Contracted $247 110%
Self Pay - Mcd Pending 100 Percent $247 110%
Single Case Agreement $247 110%
Naphcare Inc $276 123%
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%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 651 E 25Th St, Hialeah, FL 33013
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals