CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sarasota Memorial Hospital - Venice

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $176
Cash Discount Price: $95
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sarasota Memorial Hospital - Venice is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.79x the Medicare baseline. Located in 2600 Laurel Road East, North Venice, FL.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$176

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: $95 (42%)

Insurance Median: $176 (79%)

Cash: $95 (42% of Medicare)

Ins. Median: $176 (79% 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
Simply Healthcare	$41 - $43	18%
Sunshine State	$43	19%
Molina	$44	20%
Amerihealth Caritas	$45	20%
Community Care Plan	$45	20%
Florida Community Care	$45 - $225	20%
Aetna	$106 - $503	47%
Careworks	$106	47%
Enlyte	$106	47%
UnitedHealthcare	$114 - $472	51%
Avmed	$134 - $459	60%
Usa Managed Care	$146 - $503	65%
First Health	$152 - $522	68%
Blue Cross Blue Shield	$204	91%
Simply Freedom Optimum	$214	96%
Wellcare	$214	96%
Ambetter / Centene	$551	246%

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 $95.
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 Sarasota Memorial Hospital - Venice 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.