CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Physicians Care Surgical Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $46
  • Cash Discount Price: $34
  • vs. Medicare Baseline: 0.21x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Physicians Care Surgical Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $34. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.21x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$34

Average discount available for prompt cash payment at this facility.

Insurance Median
$46

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: $34 (15%)
Insurance Median: $46 (21%)
Cash: $34 (15% of Medicare)
Ins. Median: $46 (21% 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.

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
Aarp $42 19%
Aetna $42 - $101 19%
Blue Cross Blue Shield $42 - $376 19%
Cigna $42 19%
Devon Health Services $42 19%
Gpm Health And Life Insurance Mc Supplement $42 19%
Humana $42 19%
Ibc Security 65 $42 19%
Keystone 65 Hmo $42 19%
Medicare (plans) $42 19%
Pcsh Aarp $42 19%
Personal Choice 65 $42 19%
Shenandoah Life $42 19%
Tricare $42 19%
Unified Health Services $42 19%
UnitedHealthcare $42 - $90 19%
Vibra Health Plan $42 19%
Amerihealth Administrators $46 21%
Amerihealth New Jersey Hmo $46 21%
Carefirst Administrators $46 21%
Empire Plan $46 21%
Horizon Of New Jersey $46 21%
Ibc $46 21%
Ibc - Local $46 21%
Ibc 2021 $46 21%
Ibc Local $46 21%
Independence Administrators $46 21%
Independence Bc $46 21%
Independence Federal $46 21%
Keystone Direct Pos $46 21%
Keystone Healthplan East $46 21%
Keystone Hmo $46 21%
Pcsh Ibc $46 21%
Personal Choice $46 21%
Regence Blue Shield $46 21%
Allsavers $90 40%
Golden Rule Op $90 40%
Oxford Health Plan $90 40%
Oxford Life Insurance Company $90 40%
Surest $90 40%
Ag Administrators $101 45%
Ag Administrators Inc $101 45%
Allied Benefit Systems $101 45%
Allied Benefits Systems $101 45%
Continental Benefits $101 45%
Coventry $101 45%
Geha $101 45%
Healthez $101 45%
Lucent Health $101 45%
Marpai Health $101 45%
Meritain Health $101 45%
Premier Care Network $101 45%
Trustmark $101 45%
Connecticare $211 94%
Highmark $376 168%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 454 Enterprise Drive, Royersford, PA 19468
  • CMS Rating: No CMS Rating
  • Ownership Type: Physician
  • Hospital Type: Acute Care Hospitals