CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $233
Cash Discount Price: $224
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UMass Memorial Health - Harrington Hospital is $233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $224. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.04x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$224

Average discount available for prompt cash payment at this facility.

Insurance Median

$233

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: $224 (100%)

Insurance Median: $233 (104%)

Cash: $224 (100% of Medicare)

Ins. Median: $233 (104% 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
Cigna	$52 - $266	23%
Wellpoint [11112]	$52	23%
Workers Compensation [20501]	$109	49%
Medicaid / KanCare	$116	52%
Fallon Connectorcare [10503]	$122	55%
Hne [11108]	$146	65%
Tufts [11201]	$159	71%
First Health Network [11120]	$168	75%
Evernorth Behavioral Health [27]	$179	80%
Aetna	$180 - $279	80%
UnitedHealthcare	$190 - $284	85%
Connecticare [11105]	$224	100%
Fallon Carelon Hlth [28]	$224	100%
Fallon Mcaid Carelon Hlth [29]	$224	100%
Grants [20507]	$224	100%
Masshealth Mcd Mbhp [38]	$224	100%
Wellsense Mcaid Carelon Hlth [21]	$224	100%
Champva [11001]	$242	108%
Institution [10406]	$266	119%
Mgb Mcr [10124]	$266	119%
Tufts Us Family [11203]	$266	119%
Blue Cross Blue Shield	$274 - $346	122%
Commonwealth Care Alliance [10103]	$279	125%
Fallon Mcr Supp [20202]	$279	125%
Fallon Mcr [10105]	$279	125%
Tufts Mcr [10112]	$279	125%
Senior Whole Health [10110]	$284	127%
Harvard Pilgrim [10701]	$408 - $490	182%
Tufts Connectorcare [10507]	$452	202%
Hsno/Free Care [10801]	$681	304%

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 $224.
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 Health - Harrington 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.