CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Hospital of Univ of Pennsylvania
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $327
- Cash Discount Price: $598
- vs. Medicare Baseline: 1.46x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hospital of Univ of Pennsylvania is $327. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $598. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.46x the Medicare baseline. Located in 3400 Spruce St, Philadelphia, PA.
Cash / Self-Pay
$598
Average discount available for prompt cash payment at this facility.
Insurance Median
$327
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: $598 (267%)
Insurance Median: $327 (146%)
Cash: $598 (267% of Medicare)
Ins. Median: $327 (146% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Partners | $18 - $1,233 | 8% |
| Paired Kidney Exchange | $19 - $185 | 8% |
| Horizon Nj Health | $32 - $217 | 14% |
| Keystone Mercy Health Plan | $38 - $1,233 | 17% |
| Preferred Health Care Eliance | $42 - $271 | 19% |
| Aetna | $43 - $1,233 | 19% |
| Pgm - Regie De L'Assurance Maladie Quebec | $44 - $284 | 20% |
| Upmc | $48 - $1,233 | 21% |
| Blue Cross Blue Shield | $51 - $752 | 23% |
| Cigna | $66 - $555 | 30% |
| Pgm - Kuwait Defense | $66 - $555 | 30% |
| Qualcare | $72 - $469 | 32% |
| Olympus | $75 - $485 | 34% |
| Coventry | $76 - $629 | 34% |
| Medicaid / KanCare | $76 - $1,233 | 34% |
| Pgm - Chop | $76 - $493 | 34% |
| Wissahickon Hospice | $76 - $493 | 34% |
| UnitedHealthcare | $77 - $1,233 | 34% |
| Healthamerica/Coventry | $86 - $604 | 38% |
| First Health Global | $95 - $616 | 42% |
| Health Net | $114 - $740 | 51% |
| Kaiser Permanente | $114 - $1,233 | 51% |
| Pgm - Royal Embassy Of Saudi Arabia | $114 - $740 | 51% |
| Gspp And Wissahickon Hospice | $115 | 51% |
| Pgm - Embassy Of Qatar | $124 - $801 | 55% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $124 - $801 | 55% |
| Interlink | $127 - $826 | 57% |
| Pgm - Embassy Of The United Emirates/Ipc | $133 - $863 | 59% |
| Health America/Ccn | $152 - $986 | 68% |
| Humana | $152 - $986 | 68% |
| Intergroup | $152 - $986 | 68% |
| Pgm - Kuwait Health Division | $152 - $986 | 68% |
| Pgm - Kuwait Oil | $152 - $986 | 68% |
| Preferred Care | $152 - $986 | 68% |
| Blue Quality Centers For Transplant (Bqct) | $190 - $1,233 | 85% |
| City Of Philadelphia Behavioral Health | $190 - $1,233 | 85% |
| Commercial Other | $190 - $1,233 | 85% |
| Ibc Commercial Hpn | $190 - $236 | 85% |
| International Pfs | $190 - $1,233 | 85% |
| Keystone Hmo Proactive | $190 - $242 | 85% |
| Pa Medical Assistance | $190 - $1,233 | 85% |
| United Behavioral Health | $190 - $1,233 | 85% |
| Workers Compensation | $190 - $1,233 | 85% |
| Medicare (plans) | $230 - $235 | 103% |
| Philadelphia Va Medical Center | $230 | 103% |
| Tricare | $230 | 103% |
| Ibc | $235 | 105% |
| Geisinger Health Plan | $237 - $730 | 106% |
| Devoted Health | $242 | 108% |
| Pa Health And Wellness | $242 - $380 | 108% |
| Penn Life (Living Independently For Elders) | $242 | 108% |
| Clover Health Plan | $249 | 111% |
| Keystone First | $255 | 114% |
| Us Family Health Plan | $265 | 118% |
| Gateway Health Plan | $285 | 127% |
| Elap | $327 | 146% |
| Claims Watcher | $368 - $414 | 164% |
| Oscar Health Plan | $391 | 175% |
| Centivo | $414 | 185% |
| Elap Services | $428 | 191% |
| Highmark | $484 | 216% |
| Penn Global Medicine | $610 | 273% |