CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: South Miami Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $143
Cash Discount Price: $171
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at South Miami Hospital is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.64x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$171

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $171 (76%)

Insurance Median: $143 (64%)

Cash: $171 (76% of Medicare)

Ins. Median: $143 (64% 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
Amerigroup	$36	16%
Medicaid / KanCare	$36 - $39	16%
UnitedHealthcare	$37 - $297	17%
Wellcare	$37	17%
Sunshine State	$38	17%
Aetna	$39 - $256	17%
Vista	$39	17%
Blue Cross Blue Shield	$40 - $237	18%
Avmed	$82 - $252	37%
Non Contracted	$84 - $109	38%
Cigna	$87 - $261	39%
Humana	$100 - $249	45%
Amerihealth	$104 - $134	46%
Medicare (plans)	$118 - $309	53%
International	$150 - $193	67%
Dimension Health Plan	$172 - $267	77%
Affordable	$196 - $252	88%
Phcs	$207 - $267	93%
Quality Health	$207 - $267	93%
Medica Health Plan	$245	110%
Leon Medical	$252	113%

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 $171.
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 South Miami 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.