CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Tri Valley Health System

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $106
Cash Discount Price: $175
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Tri Valley Health System is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.47x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $175 (78%)

Insurance Median: $106 (47%)

Cash: $175 (78% of Medicare)

Ins. Median: $106 (47% 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
Blue Cross Blue Shield	$34 - $251	15%
Humana	$34 - $116	15%
Medica Mcr Adv	$34 - $116	15%
Medica Prime Sol	$34 - $116	15%
Tricare	$34 - $116	15%
Wellcare Mcr Adv - All Plans	$34 - $116	15%
Great Plains Mcr Adv - All Plans	$36 - $122	16%
Healthy Blue Mcaid - All Plans	$37 - $127	17%
Molina Mcaid - All Plans	$37 - $127	17%
Nebraska Total Care-All Plans	$37 - $127	17%
UnitedHealthcare	$37 - $253	17%
Amerigroup Mcaid - All Plans	$38 - $129	17%
Medica Chi Aco - All Other Plans	$70 - $238	31%
Medica Chi Open Access	$70 - $238	31%
Medica Ifb Aco	$70 - $238	31%
Medica Ifb Open Access	$70 - $238	31%
Midlands Choice-All Plans	$70 - $238	31%
Aetna	$76 - $259	34%
Multiplan-All Plans	$76 - $259	34%

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 $175.
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 Tri Valley 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.