CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Forks Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $311
Cash Discount Price: $394
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Forks Community Hospital is $311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $394. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.39x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$394

Average discount available for prompt cash payment at this facility.

Insurance Median

$311

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: $394 (176%)

Insurance Median: $311 (139%)

Cash: $394 (176% of Medicare)

Ins. Median: $311 (139% 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	$29 - $330	13%
Coordinated Care (Mco) Mcd-All Plans	$31 - $336	14%
UnitedHealthcare	$37 - $765	17%
Community Health Network Mcr-All Other Plans	$38 - $405	17%
Humana	$38 - $405	17%
Tricare	$38 - $405	17%
Triwest-All Plans	$38 - $405	17%
Ambetter / Centene	$44 - $470	20%
Wellcare Med Adv - All Plans	$44 - $470	20%
Regence-All Other Plans	$48 - $518	21%
Community Health Exchange	$55 - $585	25%
Molina Commercial-All Other Plans	$77 - $828	34%
Aetna	$80 - $855	36%
Blue Cross Blue Shield	$80 - $855	36%
Cigna	$84 - $900	38%
First Choice-All Plans	$84 - $900	38%
Medicare (plans)	$318	142%

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 $394.
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 Forks Community 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.