CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ascension St Vincent's Southside

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $206
Cash Discount Price: $57
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ascension St Vincent's Southside is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.92x the Medicare baseline. Located in 4201 Belfort Rd, Jacksonville, FL.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

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: $57 (25%)

Insurance Median: $206 (92%)

Cash: $57 (25% of Medicare)

Ins. Median: $206 (92% 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
Humana	$19 - $206	8%
Occunet	$179 - $459	80%
Bc Advantage Mcr Replacement	$204	91%
Blue Cross Blue Shield	$204	91%
Community Hospice	$204	91%
Coventry Mcr Replacement Hmo	$204	91%
Haven Hospice	$204	91%
Medicare (plans)	$204 - $208	91%
Pace Place	$204	91%
Research Study Encore Borland-Groover	$204	91%
Veterans Administration	$204	91%
Wellcare	$204	91%
Cigna	$206 - $208	92%
UnitedHealthcare	$206	92%
Careplus Mcr Replacement	$208	93%
Aetna	$210 - $419	94%
Bright Health	$276 - $296	123%
Smarthealth	$286	128%
Oscar Health Plan	$327	146%
Employer Direct Healthcare	$357	160%
90 Degree Benefits	$367	164%
Avmed Exchange	$367	164%
Molina Exchange	$378	169%
Ambetter / Centene	$388	173%

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 $57.
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 Ascension St Vincent's Southside 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.