CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Southcoast Hospitals Group

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $251
Cash Discount Price: $270
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Southcoast Hospitals Group is $251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $270. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.12x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$270

Average discount available for prompt cash payment at this facility.

Insurance Median

$251

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: $270 (121%)

Insurance Median: $251 (112%)

Cash: $270 (121% of Medicare)

Ins. Median: $251 (112% 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
Wellpoint [1000102]	$62	28%
Blue Cross Blue Shield	$86 - $289	38%
Wellsense Health Plan Clarity Connectorcare & Meta	$115	51%
Medicare (plans)	$133 - $290	59%
Wellsense Health Plan [1010202]	$158	71%
Tufts Health Public Plans [1010213]	$181 - $412	81%
UnitedHealthcare	$183 - $254	82%
Tufts [1010701]	$226	101%
Aetna	$242 - $411	108%
Evercare [1010304]	$242	108%
Tufts Senior Care Options [1010315]	$242	108%
Wellsense Health Plan Senior Care Options [1020208	$244	109%
Commonwealth Care Alliance [1080501]	$249 - $251	111%
Eternal Health [1010322]	$266	119%
Mass General Brigham Health Plan Commercial [10122	$304	136%
Mass General Brigham Health Plan Connectorcare [10	$304	136%
Group Insurance Service Center [1013001]	$324	145%
Innovative Health Plan [1025001]	$324	145%
Priority Health [1015001]	$324	145%
Fallon [1000114]	$338	151%
PHCS [1000125]	$351	157%
Cigna	$355	159%
Harvard Pilgrim [1010602]	$364	163%
First Health [1000130]	$411	184%

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 $270.
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 Southcoast Hospitals Group 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.