CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Palmetto General Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $200
- Cash Discount Price: $628
- vs. Medicare Baseline: 0.89x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Palmetto General Hospital is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $628. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.89x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$628
Average discount available for prompt cash payment at this facility.
Insurance Median
$200
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: $628 (281%)
Insurance Median: $200 (89%)
Cash: $628 (281% of Medicare)
Ins. Median: $200 (89% 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
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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 | $19 - $447 | 8% |
| Humana | $37 - $255 | 17% |
| Medicaid / KanCare | $37 - $628 | 17% |
| UnitedHealthcare | $38 - $625 | 17% |
| Bc/Bs Of Fl Network Blue | $96 | 43% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $102 | 46% |
| Cigna | $109 - $314 | 49% |
| Oscar Health Plan Hix | $114 | 51% |
| Bc/Bs Of Fl Health Options Hmo | $120 | 54% |
| Bc/Bs Myblue Hmo Hix | $127 | 57% |
| Bc/Bs Of Fl Miami Dade Blue Select | $127 | 57% |
| Bc/Bs Of Fl Simplyblue | $133 | 59% |
| Veterans Administration Mill Bill | $138 | 62% |
| Bc/Bs Of Fl Ppo | $157 | 70% |
| Imagine Health | $161 | 72% |
| Avmed Broad Network | $170 | 76% |
| Medicare (plans) | $177 - $628 | 79% |
| Leon Health Inc | $196 | 88% |
| Devoted Health | $197 | 88% |
| Tricare | $198 | 89% |
| Bristol Hospice- Miami Dade Llc | $200 | 89% |
| Catholic Hospice | $200 | 89% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $200 | 89% |
| Hospice Other | $200 | 89% |
| Ima Evalutations Inc | $200 | 89% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $200 | 89% |
| Opuscare Of South Fl | $200 | 89% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $200 | 89% |
| Select Specialty Hospital | $200 | 89% |
| Veterans Administration Vaccn | $200 | 89% |
| Vitas Healthcare Hospice | $200 | 89% |
| Westchester General Hospital | $200 | 89% |
| Longevity Health Plan | $210 | 94% |
| Florida Pace Centers | $236 | 105% |
| Bright Health Management Commercial | $240 | 107% |
| Naphcare Inc | $276 | 123% |
| Liga Contra El Cancer | $314 | 140% |
| Bc/Bs Of Fl Phs | $315 | 141% |
| Avmed Exchange | $350 | 156% |
| Ambetter / Centene | $370 | 165% |
| Magellan Behavioral Health | $377 | 169% |
| Molina Marketplace Program Exchange | $381 | 170% |
| Auto Insurance | $400 | 179% |
| Dimensions International | $408 | 182% |
| Avmed Select Network | $410 | 183% |
| First Health | $421 | 188% |
| Amerihealth Caritas Next Exchange | $430 | 192% |
| Dimension Health Ppo | $471 | 211% |
| Dimension Health Wc | $471 | 211% |
| Workers Compensation | $471 | 211% |
| Beacon Health Strategies Commercial | $628 | 281% |
| Commercial Non-Contracted | $628 | 281% |
| Self Pay - Mcd Pending 100 Percent | $628 | 281% |
| Single Case Agreement | $628 | 281% |
| United Behavioral Health Psych | $628 | 281% |