CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Capital Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $561
Cash Discount Price: $470
vs. Medicare Baseline: 2.51x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Capital Medical Center is $561. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $470. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.51x the Medicare baseline. Located in 3900 Capital Mall Dr Sw, Olympia, WA.

Cash / Self-Pay

$470

Average discount available for prompt cash payment at this facility.

Insurance Median

$561

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: $470 (210%)

Insurance Median: $561 (251%)

Cash: $470 (210% of Medicare)

Ins. Median: $561 (251% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 251% of the Medicare baseline (a markup of 151%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Community Health Plan Of Washington	$5 - $373	2%
Coordinated Care	$5	2%
Molina	$5 - $409	2%
UnitedHealthcare	$5 - $1,073	2%
Wellpoint	$8	4%
Regence	$223	100%
Aetna	$228 - $660	102%
Wellcare	$232	104%
Premera	$359 - $561	160%
Pacificsource	$399 - $610	178%
Ambetter / Centene	$409	183%
Cigna	$641 - $679	287%
First Choice	$737 - $1,170	329%
Kaiser	$817	365%
Multiplan/Phcs	$833 - $966	372%
First Health	$970 - $1,027	434%

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 $470.
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 Capital Medical Center 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.