CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Astria Toppenish Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $218
  • Cash Discount Price: $437
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Astria Toppenish Hospital is $218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $437. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.97x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.
Cash / Self-Pay
$437

Average discount available for prompt cash payment at this facility.

Insurance Median
$218

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: $437 (195%)
Insurance Median: $218 (97%)
Cash: $437 (195% of Medicare)
Ins. Median: $218 (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

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
Ambetter / Centene $6 3%
Medicaid / KanCare $6 - $381 3%
Medicare (plans) $6 - $666 3%
Molina $6 3%
UnitedHealthcare $6 - $666 3%
Va $6 - $161 3%
Molina_Exchange $7 3%
Premera_Affordable_Care $20 - $304 9%
Chpw_Cascade_Care $33 - $508 15%
First_Choice $36 - $556 16%
Tpsc $41 - $629 18%
Aetna $46 - $709 21%
Bcchp $52 - $806 23%
Great_Rivers $52 - $806 23%
Healthcomp $52 - $806 23%
Humana $52 - $806 23%
Washington_State_Hca $52 - $806 23%
Regence $72 - $273 32%
Premera $80 - $304 36%
Li $200 89%
Cigna $218 97%
Tricare $218 97%
Zenith $220 98%
Kaiser $763 341%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 502 W Fourth Ave, Toppenish, WA 98948
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals