CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Portsmouth Regional Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $621
Cash Discount Price: $1,172
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Portsmouth Regional Hospital is $621. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,172. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.78x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$1,172

Average discount available for prompt cash payment at this facility.

Insurance Median

$621

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: $1,172 (524%)

Insurance Median: $621 (278%)

Cash: $1,172 (524% of Medicare)

Ins. Median: $621 (278% 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 278% of the Medicare baseline (a markup of 178%). 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
Amerihealth Caritas	$48	21%
Well Sense Health Plan	$96	43%
United	$301 - $774	135%
Maine Community Health	$366 - $621	164%
Harvard Pilgrim	$382 - $503	171%
Tufts Health Plan	$441 - $670	197%
Blue Cross Blue Shield	$519	232%
Aetna	$742	332%
Mvp Health Plan	$820	367%
Corvel	$844	377%
Evernorth	$938	419%
Mutual Of Omaha	$938	419%
Multiplan	$949	424%
First Health	$1,067	477%
Healthcare Value Mgmt	$1,067	477%
Oxford Health Plans	$1,113	497%

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 $1,172.
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 Portsmouth Regional 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.