CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Nemours Childrens Hospital, Florida

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $388
Cash Discount Price: $786
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Nemours Childrens Hospital, Florida is $388. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $786. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.73x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$786

Average discount available for prompt cash payment at this facility.

Insurance Median

$388

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: $786 (351%)

Insurance Median: $388 (173%)

Cash: $786 (351% of Medicare)

Ins. Median: $388 (173% 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
Avmed	$126 - $312	56%
Employers Health Network Fl	$162 - $402	72%
Florida Blue	$162 - $614	72%
Truli	$162 - $402	72%
Aetna	$178 - $443	80%
Evolutions Healthcare	$182 - $453	81%
Tricare	$204	91%
Integra Administrative Group	$243 - $604	109%
Cigna	$248	111%
Global Medical Management	$263 - $654	118%
Prime Health Services	$263 - $654	118%
Star Healthcare Network	$263 - $654	118%
UnitedHealthcare	$274	122%
Velocity	$304 - $754	136%
First Health Network	$316 - $785	141%
Pnoa	$324 - $805	145%
Seminole Tribe Of Fl	$324 - $805	145%
Private Healthcare Systems	$373 - $926	167%

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 $786.
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 Nemours Childrens Hospital, Florida 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.