CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Pennsylvania Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $266
- Cash Discount Price: $410
- vs. Medicare Baseline: 1.19x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Pennsylvania Hospital is $266. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $410. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.19x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$410
Average discount available for prompt cash payment at this facility.
Insurance Median
$266
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: $410 (183%)
Insurance Median: $266 (119%)
Cash: $410 (183% of Medicare)
Ins. Median: $266 (119% 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 - $609 | 8% |
| Horizon Nj Health | $65 - $107 | 29% |
| Medicaid / KanCare | $69 - $609 | 31% |
| Keystone Mercy Health Plan | $77 - $122 | 34% |
| UnitedHealthcare | $79 - $609 | 35% |
| Pgm - Regie De L'Assurance Maladie Quebec | $89 - $140 | 40% |
| Upmc | $96 - $609 | 43% |
| Preferred Health Care Eliance | $100 - $158 | 45% |
| Blue Cross Blue Shield | $104 - $609 | 46% |
| Aetna | $107 - $609 | 48% |
| Cigna | $130 - $236 | 58% |
| Pgm - Kuwait Defense | $135 - $274 | 60% |
| Devon | $146 - $274 | 65% |
| Qualcare | $146 - $231 | 65% |
| Coventry | $154 - $311 | 69% |
| Pgm - Chop | $154 - $244 | 69% |
| Wissahickon Hospice | $154 - $244 | 69% |
| Healthamerica/Coventry | $173 - $298 | 77% |
| Olympus | $187 - $296 | 84% |
| First Health Global | $192 - $304 | 86% |
| Urn-Cancer Resource Services | $192 - $304 | 86% |
| Medicare (plans) | $229 - $234 | 102% |
| Philadelphia Va Medical Center | $229 | 102% |
| Tricare | $230 | 103% |
| Health Net | $231 - $365 | 103% |
| Pgm - Royal Embassy Of Saudi Arabia | $231 - $365 | 103% |
| Ibc | $234 | 105% |
| Geisinger Health Plan | $236 - $726 | 105% |
| Humana | $236 - $487 | 105% |
| Ibc Commercial Hpn | $236 | 105% |
| Pa Health And Wellness | $240 - $378 | 107% |
| Penn Life (Living Independently For Elders) | $240 | 107% |
| Keystone Hmo Proactive | $242 | 108% |
| Clover Health Plan | $247 | 110% |
| Pgm - Embassy Of Qatar | $250 - $396 | 112% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $250 - $396 | 112% |
| Keystone First | $254 | 114% |
| Us Family Health Plan | $265 | 118% |
| Pgm - Embassy Of The United Emirates/Ipc | $270 - $426 | 121% |
| Gateway Health Plan | $284 | 127% |
| Devon Health Services Inc | $308 - $487 | 138% |
| Health America/Ccn | $308 - $487 | 138% |
| Intergroup | $308 - $487 | 138% |
| Pgm - Kuwait Health Division | $308 - $487 | 138% |
| Pgm - Kuwait Oil | $308 - $487 | 138% |
| Preferred Care | $308 - $487 | 138% |
| Elap | $325 | 145% |
| Claims Watcher | $366 - $412 | 164% |
| Commercial Other | $385 - $609 | 172% |
| Community Behavioral Health | $385 - $609 | 172% |
| International Pfs | $385 - $609 | 172% |
| Quest Behavioral Health | $385 - $609 | 172% |
| United Behavioral Health | $385 - $609 | 172% |
| Workers Compensation | $385 - $609 | 172% |
| Oscar Health Plan | $389 | 174% |
| Centivo | $412 | 184% |
| Elap Services | $426 | 190% |
| Highmark | $482 | 215% |
| Penn Global Medicine | $607 | 271% |