CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Cambridge Health Alliance

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $70
Cash Discount Price: $70
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cambridge Health Alliance is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.31x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $70 (31%)

Insurance Median: $70 (31%)

Cash: $70 (31% of Medicare)

Ins. Median: $70 (31% 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
Wc [90001]	$16	7%
Wellpoint [50012]	$40	18%
Mass General Brigham [50021]	$45	20%
Multiplan [50010]	$48	21%
Aetna	$61 - $70	27%
Aarp [40001]	$62	28%
Oxford Health [40004]	$62	28%
United Medical Resource [40005]	$62	28%
UnitedHealthcare	$62 - $552	28%
Altus Dental [99011]	$70	31%
Beacon Health Strategies [50002]	$70	31%
Blue Cross Blue Shield	$70 - $447	31%
Cbhc Uninsured Crisis Alt Payer [70097]	$70	31%
Cbhc Uninsured Crisis [70096]	$70	31%
Celticare [50004]	$70	31%
Cigna	$70 - $410	31%
Commonwealth Care Alliance Dental [99004]	$70	31%
Coverage Discovery [90004]	$70	31%
Delta Dental Of Ma [99007]	$70	31%
Dominion National Dental [99012]	$70	31%
Dph Tb Payor [85004]	$70	31%
Esp Dental [99003]	$70	31%
Eyemed Alt Payor [13001]	$70	31%
First Health [50007]	$70	31%
Global Medical Management [50024]	$70	31%
Government Employee Health Association [50023]	$70	31%
Guardian Dental [99013]	$70	31%
Health Safety Net Dental [99002]	$70	31%
Humana	$70	31%
Ma Laborers Health And Welfare Fund [50022]	$70	31%
Magellan Health Services [65098]	$70	31%
Mass Health Dental [99001]	$70	31%
Medical Mutual Of Ohio [50019]	$70	31%
Medicare (plans)	$70	31%
Metlife Dental [99008]	$70	31%
Modern Assistance Program [30098]	$70	31%
Mva [90002]	$70	31%
Neighborhood Health Plan [50011]	$70	31%
Other Bh Payor [50014]	$70	31%
Other Commercial Payor [50015]	$70	31%
Other Dental Payor [99014]	$70	31%
Other Dual Eligible Payer [65004]	$70	31%
Other Gov'T Alt [85006]	$70	31%
Other Vision Payor [50013]	$70	31%
Ri Neighborhood Health Plan [50017]	$70	31%
Tricare	$70	31%
Other Tufts Health Public Plan [75002]	$375	168%
Tufts Health Plan [30001]	$410 - $544	183%
Health Plans Inc [20002]	$552	247%
Hphc [20001]	$552	247%

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 $70.
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 Cambridge Health Alliance 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.