CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Francis Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $244
Cash Discount Price: $17,315
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Francis Hospital is $244. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,315. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.09x the Medicare baseline. Located in 7Th and Clayton Sts, Wilmington, DE.

Cash / Self-Pay

$17,315

Average discount available for prompt cash payment at this facility.

Insurance Median

$244

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: $17,315 (7740%)

Insurance Median: $244 (109%)

Cash: $17,315 (7740% of Medicare)

Ins. Median: $244 (109% 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
Blue Benefit Administrators Of Massachusetts	$57	25%
Blue Care Network	$57	25%
Blue Cross Blue Shield	$57 - $7,253	25%
Blue Distinction Transplant	$57	25%
Blue Shield - Ca	$57	25%
Blue Shield - Id (Regence)	$57	25%
Blue Shield - Ny Highmark Northeastern	$57	25%
Blue Shield - Ny Highmark Western	$57	25%
Blue Shield - Pa (Highmark)	$57	25%
Blue Shield - Wa (Regence)	$57	25%
Medicaid / KanCare	$162	72%
Pace-Trinity Health	$228 - $2,608	102%
Saint Francis Life	$228 - $2,608	102%
Cigna	$235 - $3,807	105%
Medicare (plans)	$239 - $3,955	107%
Blue Shield - De (Highmark) Medciare Advantage	$240 - $3,885	107%
Highmark Health Options Dual Plan	$240 - $3,885	107%
Aetna	$247 - $3,992	110%
Delaware First Health	$261	117%
Coventry	$280 - $4,526	125%
Meritain	$301	135%
Trustmark Small Business Benefits	$301	135%
Devon Health Services	$440	197%
Galaxy Health Network	$440	197%
Multiplan	$440	197%
Prime Health Services	$440	197%
Three Rivers Provider Network	$440	197%
Wc Corvel	$440	197%
Geha	$444	198%
UnitedHealthcare	$444	198%
Amerihealth	$449 - $7,253	201%

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 $17,315.
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 St Francis 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.