CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Buffalo Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $159
Cash Discount Price: $117
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Buffalo Hospital is $159. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.71x the Medicare baseline. Located in 303 Catlin Street, Buffalo, MN.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$159

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: $117 (52%)

Insurance Median: $159 (71%)

Cash: $117 (52% of Medicare)

Ins. Median: $159 (71% 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
Ucare Pmap (A B C D E G N O S U R H)	$42	19%
Blue Cross Blue Shield	$45 - $237	20%
Aetna	$93 - $214	42%
Medica Health System	$106 - $168	47%
Healthpartners	$141	63%
UnitedHealthcare	$144	64%
Health Partners	$154 - $509	69%
Medica	$159 - $235	71%
Medica Mhps	$159	71%
Americas Ppo (Araz)(B D N O R S V)	$161	72%
Medica Ub Health (B)	$166	74%
Americas Ppo (Araz) (B D N H O R S)	$175	78%
First Health (A C E G H U B D N O R S)	$175	78%
All Other Contracted Care (A B C D E G H N O R S U)	$208	93%
Medicaid / KanCare	$209	93%
South Country Health Alliance	$215	96%
Medicare (plans)	$226	101%

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 $117.
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 Buffalo 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.