CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Astria Sunnyside Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $144
Cash Discount Price: $154
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Astria Sunnyside Hospital is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.64x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $154 (69%)

Insurance Median: $144 (64%)

Cash: $154 (69% of Medicare)

Ins. Median: $144 (64% 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
Medicare (plans)	$9 - $76	4%
Aetna	$59 - $263	26%
Healthcomp_Ihs	$59 - $73	26%
Humana	$59 - $269	26%
Medicaid / KanCare	$59 - $92	26%
Molina	$59 - $73	26%
Tricare	$59 - $74	26%
Va	$59 - $73	26%
Regence	$123 - $154	55%
Cigna	$144 - $179	64%
Li	$147 - $184	66%
First_Choice	$180 - $224	80%
Tpsc	$187 - $233	84%
Kaiser	$188 - $235	84%
Premera	$195 - $243	87%
UnitedHealthcare	$204 - $254	91%
Fhpw	$211 - $263	94%
Healthcomp	$216 - $269	97%
Bcchp	$240 - $299	107%
Great_Rivers	$240 - $299	107%
Zenith	$240 - $299	107%

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 $154.
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 Astria Sunnyside 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.