CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Medstar Harbor Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $1,056
Cash Discount Price: $1,034
vs. Medicare Baseline: 4.72x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Medstar Harbor Hospital is $1,056. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,034. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 4.72x the Medicare baseline. Located in 3001 South Hanover Street, Baltimore, MD.

Cash / Self-Pay

$1,034

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,056

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: $1,034 (462%)

Insurance Median: $1,056 (472%)

Cash: $1,034 (462% of Medicare)

Ins. Median: $1,056 (472% 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 472% of the Medicare baseline (a markup of 372%). 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	$162 - $1,949	72%
Amerigroup	$162 - $1,949	72%
Amerihealth Caritas District Of Columbia	$162 - $1,949	72%
Carefirst Advantage Inc	$162 - $1,949	72%
Carefirst Blue Choice Inc	$162 - $1,949	72%
Cigna	$162 - $1,949	72%
First Health	$162 - $1,949	72%
Hscsn	$162 - $1,949	72%
Humana	$162 - $1,949	72%
Kaiser Permanente	$162 - $1,949	72%
Magellan Behavioral Health Inc	$162 - $1,949	72%
Mamsi	$162 - $1,949	72%
Medstar Family Choice	$162 - $1,949	72%
Medstar Family Choice Inc	$162 - $1,949	72%
Ncppo Healthlink Ppo	$162 - $1,949	72%
Pfc	$162 - $1,949	72%
Private Healthcare Systems (Phcs)	$162 - $1,949	72%
Tricare	$162 - $1,949	72%
United Behavioral Health Inc	$162 - $1,949	72%
UnitedHealthcare	$162 - $1,949	72%

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 $1,034.
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 Harbor 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.