CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $266
Cash Discount Price: $273
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UMass Memorial Healthalliance Hospitals is $266. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $273. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.19x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$273

Average discount available for prompt cash payment at this facility.

Insurance Median

$266

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: $273 (122%)

Insurance Median: $266 (119%)

Cash: $273 (122% of Medicare)

Ins. Median: $266 (119% 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
Grants [20507]	$13 - $273	6%
Wellpoint [11112]	$52	23%
Workers Compensation [20501]	$90	40%
UnitedHealthcare	$93 - $284	42%
Fallon Connectorcare [10503]	$122	55%
Medicaid / KanCare	$142 - $266	63%
Institution [10406]	$145 - $266	65%
Hne [11108]	$152	68%
Aetna	$179 - $279	80%
Cigna	$180 - $464	80%
First Health Network [11120]	$205	92%
Multiplan [11109]	$205	92%
Champva [11001]	$217	97%
Medicare (plans)	$262 - $266	117%
Correctional Care [11003]	$266	119%
Tufts Dual [10111]	$266	119%
Tufts Us Family [11203]	$266	119%
Connecticare [11105]	$273	122%
Fallon Carelon Hlth [28]	$273	122%
Fallon Mcaid Carelon Hlth [29]	$273	122%
Blue Cross Blue Shield	$274 - $354	122%
Commonwealth Care Mcr [10115]	$279	125%
Fallon Mcr Supp [20202]	$279	125%
Harvard Pilgrim Mcr [10106]	$279	125%
Mgb Mcr [10124]	$279	125%
Tufts Mcr [10112]	$279	125%
Senior Whole Health [10110]	$284	127%
Hsno/Free Care [10801]	$294	131%
Harvard Pilgrim [10701]	$399 - $479	178%
Tufts [11201]	$422	189%
Tufts Connectorcare [10507]	$452	202%

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 $273.
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 UMass Memorial Healthalliance Hospitals 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.