CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mary Bridge Children's Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $884
Cash Discount Price: $543
vs. Medicare Baseline: 3.95x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mary Bridge Children's Hospital is $884. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $543. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 3.95x the Medicare baseline. Located in 317 Martin Luther King Jr W Box 5299, Tacoma, WA.

Cash / Self-Pay

$543

Average discount available for prompt cash payment at this facility.

Insurance Median

$884

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: $543 (243%)

Insurance Median: $884 (395%)

Cash: $543 (243% of Medicare)

Ins. Median: $884 (395% 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 395% of the Medicare baseline (a markup of 295%). 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 - $249	2%
Coordinated Care	$5	2%
Molina	$5 - $418	2%
UnitedHealthcare	$5 - $1,884	2%
Wellpoint	$5	2%
Ambetter / Centene	$17	8%
Aetna	$233 - $1,391	104%
Regence	$233 - $1,156	104%
Wellcare	$237	106%
Premera	$359 - $979	160%
Pacificsource	$572 - $577	256%
First Choice	$884 - $1,049	395%
First Health	$1,086	485%
Multiplan/Phcs	$1,086	485%
Cigna	$1,105 - $1,133	494%
Uniform Medical	$1,149	514%
Kaiser	$1,483	663%

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 $543.
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 Mary Bridge Children's 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.