CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Boston Medical Center-Brighton

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $262
Cash Discount Price: $131
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Boston Medical Center-Brighton is $262. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.17x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$262

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: $131 (59%)

Insurance Median: $262 (117%)

Cash: $131 (59% of Medicare)

Ins. Median: $262 (117% 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
Unicare [8004]	$35	16%
Wellpoint [2034]	$35	16%
Aetna	$214 - $262	96%
Meritain Health [1023]	$214	96%
Mass General Brigham Health Plan Commercial [8009]	$221	99%
Mass General Brigham Health Plan Prime [7003]	$221	99%
Blue Cross Blue Shield	$262 - $379	117%
Humana	$262	117%
Medicare (plans)	$262 - $276	117%
Neighborhood Pace [1206]	$262	117%
Senior Whole Health [1210]	$262	117%
Ubh Hphc [8016]	$262	117%
United Community Plan [1202]	$262	117%
UnitedHealthcare	$262	117%
Veterans Admin [9003]	$262	117%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$262	117%
Cca [1215]	$276	123%
Zzzcca Onecare [1216]	$276	123%
Eternalhealth [1227]	$278	124%
Fallon [8008]	$341	152%
Harvard Pilgrim Health Care [8001]	$423	189%
Hsn Bad Debt [4003]	$475	212%
Hsn Confidential [4007]	$475	212%
Hsn Dental [4006]	$475	212%
Hsn Partial [4002]	$475	212%
Hsn [4001]	$475	212%
Tufts [8002]	$610 - $692	273%
Cigna	$692	309%

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 $131.
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 Boston Medical Center-Brighton 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.