CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Doctors Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $151
Cash Discount Price: $193
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Doctors Hospital is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.67x the Medicare baseline. Located in 5000 University Dr, Coral Gables, FL.

Cash / Self-Pay

$193

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

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: $193 (86%)

Insurance Median: $151 (67%)

Cash: $193 (86% of Medicare)

Ins. Median: $151 (67% 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	$52 - $237	23%
Humana	$100 - $249	45%
Avmed	$101 - $252	45%
Leon Medical	$102 - $256	46%
Cigna	$104 - $261	46%
Non Contracted	$109	49%
Medicare (plans)	$118 - $309	53%
Amerihealth	$134	60%
International	$193	86%
Dimension Health Plan	$223 - $267	100%
Medica Health Plan	$245	110%
Affordable	$252	113%
Phcs	$267	119%
Quality Health	$267	119%

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 $193.
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 Doctors 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.