CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Duke University Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $70
Cash Discount Price: $227
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Duke University Hospital is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $227. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.31x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$227

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $227 (101%)

Insurance Median: $70 (31%)

Cash: $227 (101% of Medicare)

Ins. Median: $70 (31% 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
Amerihealth	$17 - $87	8%
Blue Cross Blue Shield	$17 - $1,088	8%
Carolina Complete Health	$17 - $87	8%
Trillium	$17 - $87	8%
Alliance Health	$19 - $87	8%
Partners	$19 - $35	8%
UnitedHealthcare	$20 - $198	9%
Aetna	$23 - $2,589	10%
Cigna	$40 - $202	18%
Medcost	$47 - $59	21%
Sentara	$67 - $86	30%
Humana	$92 - $203	41%
Troy Health	$198	89%
Voans	$198	89%
Liberty	$202	90%

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 $227.
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 Duke University 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.