CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Gulf Breeze Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $46
Cash Discount Price: $12
vs. Medicare Baseline: 0.21x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Gulf Breeze Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.21x the Medicare baseline. Located in 1110 Gulf Breeze Pkwy, Gulf Breeze, FL.

Cash / Self-Pay

$12

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $12 (5%)

Insurance Median: $46 (21%)

Cash: $12 (5% of Medicare)

Ins. Median: $46 (21% 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
Aetna	$9 - $214	4%
Fl Blue	$12 - $341	5%
Pensacola	$12	5%
Uwf Athletes	$20 - $54	9%
Bc Fl	$22	10%
UnitedHealthcare	$22 - $205	10%
Hospice Regency	$25	11%
Cha Health Plan	$37	17%
Cigna	$39 - $83	17%
Humana	$39 - $83	17%
Sunshine Health	$39	17%
Wellcare	$39 - $214	17%
Fl Community Care Ltc	$40	18%
Hospice Emerald Coast	$42	19%
Simply Healthcare Healthy Kids	$43	19%
Private Healthcare	$54	24%
First Health	$58	26%
Wc Corvel	$59 - $86	26%
Choicecare	$62	28%
Multiplan	$74	33%
Medicare (plans)	$173	77%
Hospice Covenant	$204	91%

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 $12.
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 Gulf Breeze 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.