CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Coral Gables Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $193
  • Cash Discount Price: $251
  • vs. Medicare Baseline: 0.86x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Coral Gables Hospital is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $251. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.86x the Medicare baseline. Located in 3100 Douglas Rd, Coral Gables, FL.
Cash / Self-Pay
$251

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: $251 (112%)
Insurance Median: $193 (86%)
Cash: $251 (112% 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 $8 - $197 4%
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 Of Fl Miami Dade Blue Select $38 17%
Bc/Bs Of Fl Network Blue $38 17%
UnitedHealthcare $38 - $568 17%
Bc/Bs Of Fl Blue Select Exchange Non Par $41 18%
Bc/Bs Myblue Hmo Hix $43 19%
Bc/Bs Of Fl Health Options Hmo $43 19%
Cigna $44 - $207 20%
Bc/Bs Of Fl Simplyblue $45 20%
Bc/Bs Of Fl Ppo $48 21%
Avmed Broad Network $61 27%
Oscar Health Plan Hix $114 51%
Bc/Bs Of Fl Phs $135 60%
Veterans Administration Mill Bill $138 62%
Imagine Health $161 72%
Dimension International $163 73%
Medicare (plans) $177 - $430 79%
First Health $178 80%
Dimension Health Ppo $188 84%
Dimension Health Wc $188 84%
Workers Compensation $188 84%
Leon Health Inc $196 88%
Devoted Health $197 88%
Tricare $198 89%
Catholic Hospice $200 89%
Hcr Manor Care Services Of Fl Ii Dba Heartland Hospice Services $200 89%
Hospice Other $200 89%
Odyssey Healthcare Of Marion County Dba Kindred Hospice $200 89%
Opus Care Of South Florida $200 89%
Seasons Hospice And Palliative Care Of Southern Florida Inc $200 89%
Veterans Administration Vaccn $200 89%
Vitas Healthcare Corporation/Hospice Ppo $200 89%
Longevity Health Plan $209 93%
Florida Pace Centers $236 105%
Bright Health Management Commercial $240 107%
Commercial Non-Contracted $251 112%
Self Pay - Mcd Pending 100 Percent $251 112%
Single Case Agreement $251 112%
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: 3100 Douglas Rd, Coral Gables, FL 33134
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals