CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Harlan County Health System

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $93
Cash Discount Price: $82
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Harlan County Health System is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.42x the Medicare baseline. Located in 717 Brown St, Alma, NE.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $82 (37%)

Insurance Median: $93 (42%)

Cash: $82 (37% of Medicare)

Ins. Median: $93 (42% 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
Medica Mcr Adv	$55	25%
Medica Prime Solution	$55	25%
Humana	$68	30%
Tricare	$68	30%
Aetna	$71	32%
Great Plains Mcr Adv-All Plans	$72	32%
Medica Chi Aco - All Other Plans	$93	42%
Medica Chi Health	$93	42%
Medica Choice	$93	42%
Blue Cross Blue Shield	$97 - $98	43%
Ohara Llc Wc- All Plans	$97	43%
Medica Ifb Aco	$98	44%
Medica Ifb Open Access	$98	44%
UnitedHealthcare	$98	44%
Phcs/Multiplan-All Plans	$100	45%

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 $82.
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 Harlan County Health System 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.