CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: HCA Florida Englewood Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $123
Cash Discount Price: $712
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at HCA Florida Englewood Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $712. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.55x the Medicare baseline. Located in 700 Medical Blvd, Englewood, FL.

Cash / Self-Pay

$712

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $712 (318%)

Insurance Median: $123 (55%)

Cash: $712 (318% of Medicare)

Ins. Median: $123 (55% 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
Corvel Corporation	$18 - $97	8%
Prime Health	$18 - $100	8%
Rockport Healthcare Group	$18 - $97	8%
Access 2 Healthcare Physicians Freedom Optimum Group Members	$28 - $39	13%
Access 2 Healthcare Physicians Freedom Health	$43 - $60	19%
Access 2 Healthcare Physicians Optimum	$43 - $60	19%
Freedom Health Care	$46 - $65	21%
Optimum Healthcare	$46 - $65	21%
Avmed	$48 - $207	21%
Truli	$51 - $100	23%
Blue Cross Blue Shield	$52 - $168	23%
Aetna	$88 - $249	39%
Simply Healthcare	$88 - $128	39%
Oscar	$89 - $124	40%
United	$98 - $373	44%
Cigna	$104 - $144	46%
Molina	$113 - $224	51%
Evolutions Healthcare Systems	$137 - $762	61%
Sunshine State Health Plan	$152 - $211	68%
Humana	$167 - $232	75%
Behealthy America	$232 - $323	104%
Healthcare Sarasota	$298 - $414	133%
Plotkin Health	$298 - $414	133%
Prime Health Sheriff	$298 - $414	133%
Multiplan	$447 - $704	200%

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 $712.
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 HCA Florida Englewood 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.