CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Roxborough Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $232
Cash Discount Price: $223
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Roxborough Memorial Hospital is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $223. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.04x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$223

Average discount available for prompt cash payment at this facility.

Insurance Median

$232

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: $223 (100%)

Insurance Median: $232 (104%)

Cash: $223 (100% of Medicare)

Ins. Median: $232 (104% 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
Blue Cross Blue Shield	$86 - $224	38%
UnitedHealthcare	$136 - $468	61%
Humana	$179	80%
Health Partners Plan	$224 - $336	100%
Medicare (plans)	$224 - $235	100%
Pa Health & Wellness	$224 - $269	100%
Tricare	$224	100%
Providers Partner Health Plan	$231	103%
Keystone	$233	104%
Spartan	$235	105%
Auto Insurance	$246	110%
Worker Compensation	$253	113%
Employer Direct Healthcare	$313	140%
Naphcare	$347	155%
Highmark	$488	218%
Cigna	$529	236%

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 $223.
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 Roxborough Memorial 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.