CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Cleveland Clinic Children's Hospital for Rehab

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $315
Cash Discount Price: $341
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cleveland Clinic Children's Hospital for Rehab is $315. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $341. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.41x the Medicare baseline. Located in 2801 Martin Luther King, Jr Drive, Cleveland, OH.

Cash / Self-Pay

$341

Average discount available for prompt cash payment at this facility.

Insurance Median

$315

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: $341 (152%)

Insurance Median: $315 (141%)

Cash: $341 (152% of Medicare)

Ins. Median: $315 (141% 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
UnitedHealthcare	$90 - $385	40%
Paramount	$97	43%
Blue Cross Blue Shield	$99 - $397	44%
Molina	$99	44%
Caresource	$101	45%
United	$101 - $301	45%
Amerihealth	$104	46%
Oscar	$158 - $202	71%
Aultcare	$178	80%
Cigna	$227 - $420	101%
Amish Community Aid Plan	$236 - $262	105%
Ohcp	$255	114%
Summacare	$260 - $264	116%
Buckeye	$287 - $348	128%
Healthsmart	$289	129%
Php	$315	141%
Phphi	$315	141%
The Health Plan	$315	141%
Upmc	$315	141%
Aetna	$337 - $525	151%
Gms	$368	164%
Medical Benefit Corp	$368	164%
Quality Care Partners	$368	164%
Cc Ehp	$372	166%
Consociate Health	$394	176%
Ohio Healthy	$420	188%
Managed Care Services	$472	211%
Multiplan	$472	211%
Three Rivers	$472	211%

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 $341.
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 Cleveland Clinic Children's Hospital for Rehab 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.