CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Penn Presbyterian Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $217
- Cash Discount Price: $340
- vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Penn Presbyterian Medical Center is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $340. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.97x the Medicare baseline. Located in 51 North 39Th Street, Philadelphia, PA.
Cash / Self-Pay
$340
Average discount available for prompt cash payment at this facility.
Insurance Median
$217
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: $340 (152%)
Insurance Median: $217 (97%)
Cash: $340 (152% of Medicare)
Ins. Median: $217 (97% 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 |
|---|---|---|
| Medicaid / KanCare | $15 - $1,946 | 7% |
| Horizon Nj Health | $17 - $342 | 8% |
| Health Partners | $18 - $1,946 | 8% |
| Keystone Mercy Health Plan | $21 - $1,946 | 9% |
| Pgm - Regie De L'Assurance Maladie Quebec | $24 - $448 | 11% |
| Preferred Health Care Eliance | $26 - $486 | 12% |
| Upmc | $26 - $1,946 | 12% |
| Blue Cross Blue Shield | $28 - $1,946 | 13% |
| Aetna | $29 - $1,946 | 13% |
| Cigna | $33 - $616 | 15% |
| Pgm - Kuwait Defense | $36 - $876 | 16% |
| Devon | $39 - $876 | 17% |
| Qualcare | $39 - $739 | 17% |
| Coventry | $41 - $992 | 18% |
| Pgm - Chop | $41 - $778 | 18% |
| Wissahickon Hospice | $41 - $778 | 18% |
| UnitedHealthcare | $42 - $1,946 | 19% |
| Healthamerica/Coventry | $46 - $954 | 21% |
| Olympus | $49 - $922 | 22% |
| First Health Global | $52 - $973 | 23% |
| Urn-Cancer Resource Services | $52 - $973 | 23% |
| Health Net | $62 - $1,168 | 28% |
| Pgm - Royal Embassy Of Saudi Arabia | $62 - $1,168 | 28% |
| Pgm - Embassy Of Qatar | $67 - $1,265 | 30% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $67 - $1,265 | 30% |
| Pgm - Embassy Of The United Emirates/Ipc | $72 - $1,362 | 32% |
| Devon Health Services Inc | $82 - $1,557 | 37% |
| Health America/Ccn | $82 - $1,557 | 37% |
| Humana | $82 - $1,557 | 37% |
| Intergroup | $82 - $1,557 | 37% |
| Pgm - Kuwait Health Division | $82 - $1,557 | 37% |
| Pgm - Kuwait Oil | $82 - $1,557 | 37% |
| Preferred Care | $82 - $1,557 | 37% |
| Commercial Other | $103 - $1,946 | 46% |
| Ibc Commercial Hpn | $103 - $236 | 46% |
| International Pfs | $103 - $1,946 | 46% |
| Keystone Hmo Proactive | $103 - $242 | 46% |
| Magellan | $103 - $1,946 | 46% |
| Quest Behavioral Health | $103 - $1,946 | 46% |
| United Behavioral Health | $103 - $1,946 | 46% |
| Workers Compensation | $103 - $1,946 | 46% |
| Medicare (plans) | $229 - $234 | 102% |
| Philadelphia Va Medical Center | $229 | 102% |
| Tricare | $230 | 103% |
| Ibc | $234 | 105% |
| Geisinger Health Plan | $236 - $726 | 105% |
| Pa Health And Wellness | $240 - $378 | 107% |
| Penn Life (Living Independently For Elders) | $240 | 107% |
| Clover Health Plan | $247 | 110% |
| Keystone First | $254 | 114% |
| Us Family Health Plan | $265 | 118% |
| Gateway Health Plan | $284 | 127% |
| Elap | $325 | 145% |
| Claims Watcher | $366 - $412 | 164% |
| Oscar Health Plan | $389 | 174% |
| Centivo | $412 | 184% |
| Elap Services | $426 | 190% |
| Highmark | $482 | 215% |
| Penn Global Medicine | $607 | 271% |