CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UW Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $89
Cash Discount Price: $41
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UW Health is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.40x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $41 (18%)

Insurance Median: $89 (40%)

Cash: $41 (18% of Medicare)

Ins. Median: $89 (40% 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
Aetna	$7 - $224	3%
Blue Cross Blue Shield	$7 - $224	3%
Medicaid / KanCare	$7	3%
Humana	$8 - $224	4%
Medicare (plans)	$8 - $246	4%
Mychoice Wi Medical Adv	$8 - $224	4%
UnitedHealthcare	$8 - $233	4%
Quartz Fully Insured	$12 - $105	5%
Quartz Aso	$13 - $165	6%
Cigna	$17 - $242	8%
Alliance Premier Network	$19 - $165	8%
The Alliance	$20 - $213	9%
Hfn	$28 - $238	13%
Ecoh	$30 - $238	13%
Wps	$39	17%
Beloit Healt System	$45 - $273	20%
Workers Comp	$51	23%
Mercy Care	$54	24%
Wps Ppo	$127 - $234	57%
Mercycare	$153 - $283	68%
First Health/Coventry	$161 - $298	72%
Health Payment Systems	$191 - $353	85%
Healthsmart	$191 - $353	85%
Sheboygan Employers Health Network	$204 - $377	91%
Multiplan	$228 - $421	102%

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 $41.
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 UW Health 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.