CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: University of Miami Hospital and Clinics

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $546
Cash Discount Price: $286
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at University of Miami Hospital and Clinics is $546. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $286. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.44x the Medicare baseline. Located in 1475 Nw 12Th Ave Suite 2175, Miami, FL.

Cash / Self-Pay

$286

Average discount available for prompt cash payment at this facility.

Insurance Median

$546

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: $286 (128%)

Insurance Median: $546 (244%)

Cash: $286 (128% of Medicare)

Ins. Median: $546 (244% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 244% of the Medicare baseline (a markup of 144%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$224 - $546	100%
Aetna	$242 - $581	108%
Solis Health	$246	110%
Humana	$254	114%
Careplus	$264	118%
Sunshine Health	$264	118%
Molina Healthcare Of Fl	$286	128%
Amerihealth Caritas Fl	$296	132%
Oscar Health Of Fl	$296	132%
Blue Cross Blue Shield	$317 - $455	142%
Cigna	$382 - $460	171%
Curative	$561	251%
Avmed	$603 - $688	270%
Employers Health Network	$635	284%
Simply Healthcare	$635	284%
First Health	$688	308%
Health First New York Health Insurance	$688	308%
Broward Health	$741	331%
Beech Street	$846	378%
Dimension Health	$846	378%
Multiplan	$846	378%

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 $286.
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 University of Miami Hospital and Clinics 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.