CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Medstar Montgomery Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $1,003
Cash Discount Price: $983
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Medstar Montgomery Medical Center is $1,003. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $983. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 4.48x the Medicare baseline. Located in 18101 Prince Philip Drive, Olney, MD.

Cash / Self-Pay

$983

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,003

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: $983 (439%)

Insurance Median: $1,003 (448%)

Cash: $983 (439% of Medicare)

Ins. Median: $1,003 (448% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 448% of the Medicare baseline (a markup of 348%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$154 - $1,851	69%
Amerigroup	$154 - $1,851	69%
Amerihealth Caritas District Of Columbia	$154 - $1,851	69%
Carefirst Advantage Inc	$154 - $1,851	69%
Carefirst Blue Choice Inc	$154 - $1,851	69%
Cigna	$154 - $1,851	69%
First Health	$154 - $1,851	69%
Hscsn	$154 - $1,851	69%
Humana	$154 - $1,851	69%
Kaiser Permanente	$154 - $1,851	69%
Magellan Behavioral Health Inc	$154 - $1,851	69%
Mamsi	$154 - $1,851	69%
Medstar Family Choice	$154 - $1,851	69%
Medstar Family Choice Inc	$154 - $1,851	69%
Ncppo Healthlink Ppo	$154 - $1,851	69%
Pfc	$154 - $1,851	69%
Private Healthcare Systems (Phcs)	$154 - $1,851	69%
Tricare	$154 - $1,851	69%
United Behavioral Health Inc	$154 - $1,851	69%
UnitedHealthcare	$154 - $1,851	69%

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 $983.
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 Medstar Montgomery Medical Center 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.