CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Northwestern Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $172
Cash Discount Price: $186
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Northwestern Memorial Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $186. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.77x the Medicare baseline. Located in 251 E Huron St, Chicago, IL.

Cash / Self-Pay

$186

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $186 (83%)

Insurance Median: $172 (77%)

Cash: $186 (83% of Medicare)

Ins. Median: $172 (77% 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
Curaechoice [6100]	$17 - $129	8%
Aetna	$35 - $550	16%
Imagine Health [6032]	$35 - $148	16%
Global Medical Management Inc [6090]	$43 - $319	19%
Medpartners [6038]	$52 - $385	23%
Blue Cross Blue Shield	$58 - $550	26%
Humana	$58 - $275	26%
Cigna	$62 - $550	28%
First Health Plan [6034]	$130 - $550	58%
Galaxy Health Network [220]	$130 - $550	58%
Healthlink [125]	$130 - $550	58%
Multiplan/Phcs [142]	$130 - $550	58%
UnitedHealthcare	$130 - $550	58%
Health'S Finest Network [126]	$172 - $225	77%

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 $186.
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 Northwestern Memorial 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.