CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Children's Hospital of Philadelphia

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $106
Cash Discount Price: $253
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Children's Hospital of Philadelphia is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $253. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.47x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$253

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $253 (113%)

Insurance Median: $106 (47%)

Cash: $253 (113% of Medicare)

Ins. Median: $106 (47% 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
Medicaid / KanCare	$42	19%
UnitedHealthcare	$42 - $139	19%
Health Partners	$48	21%
Aetna	$67 - $126	30%
Highmark Wholecare	$69	31%
Upmc Medical Assistance	$69	31%
Keystone First Chip	$78	35%
Keystone Health Plan East	$80	36%
Blue Cross Blue Shield	$89 - $101	40%
Horizon Nj Health	$95	42%
Geisinger Medical Assistance	$101	45%
Geisinger Health Plan Commercial	$111	50%
Jefferson Health Plans	$120	54%
Cigna	$126	56%
Highmark	$126	56%
Qualcare	$139	62%
First Health Network	$164	73%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$202	90%
Private Health Care Systems	$202	90%
Choice Care Network	$228	102%

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 $253.
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 Children's Hospital of Philadelphia 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.