CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Medstar Health Physical Therapy

Billing Code: 94640 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$113

about 0.5× the $224 Medicare rate · typically $17–$219

modeled estimate · not a bill or quote

What this hospital charges insurers

$235

Well above the fair price

about $122 over the fair price · 1.0× Medicare

Medicare pays $224 Fair price $113 This hospital $235 Cash price $157 Hospital's list price $241

How we calculate the fair BaseRate →

How this hospital compares to other DC hospitals

One of the lower prices — 2 of 3 other DC hospitals charge more for the same procedure.

Cheapest $39 Priciest $266

Black dot = this hospital, among the 4 DC hospitals with a price for this procedure. Full list below.

A fair price for a Breathing treatment (nebulizer) is about $113 (about 0.5× the $224 Medicare rate). Medstar Health Physical Therapy charges insurers about $235, or about $157 in cash — well above the fair price. Located in Washington, DC.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $113. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$164 - $234	73%
Blue Cross Blue Shieldmajor	$118 - $229	53%
Aetnamajor	$169 - $236	76%
Cignamajor	$205	92%
Humanamajor	$241	108%
Kaiser Permanentemajor	$110 - $241	49%
+ 2 smaller / regional plans	$171 - $241

Government programs also on file: Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 157), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 94640.

Insurance Before you use insurance

Call your insurance company to confirm Medstar Health Physical Therapy is in-network.
Ask your insurer whether prior approval is required for CPT code 94640.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Medstar Health Physical Therapy

Compare: Breathing treatment (nebulizer) at other DC hospitals

Insurance negotiated median for the same procedure, sorted lowest first.