CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Phelps Memorial Health Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $92
Cash Discount Price: $160
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Phelps Memorial Health Center is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $160. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.41x the Medicare baseline. Located in 1215 Tibbals St, Holdrege, NE.

Cash / Self-Pay

$160

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $160 (72%)

Insurance Median: $92 (41%)

Cash: $160 (72% of Medicare)

Ins. Median: $92 (41% 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
UnitedHealthcare	$16 - $209	7%
Aetna	$17 - $198	8%
Blue Cross Blue Shield	$17 - $204	8%
Good Samaritan Mcr Adv - All Plans	$17 - $92	8%
Medica Mcr Adv	$17 - $92	8%
Molina Mcaid - All Plans	$17 - $95	8%
Va Ccn - All Plans	$17 - $92	8%
Wellcare Mcr Adv - All Plans	$17 - $92	8%
Three Rivers - All Plans	$20 - $111	9%
6 Degrees Hlth - All Plans	$31 - $172	14%
Partners Hlth Alliance - All Plans	$31 - $172	14%
Cpi Benefit Group-All Plans	$35 - $194	16%
Providrs Care/Wppa - All Plans	$35 - $194	16%
Provider Network Of American - All Plans	$36 - $200	16%
Chi Health Partners - All Plans	$37 - $204	17%
First Health - All Plans	$37 - $204	17%
Medica-All Other Plans	$37 - $202	17%
Midwest Ntwrk Alliance - All Plans	$37 - $204	17%
Ambetter / Centene	$44 - $240	20%

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 $160.
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 Phelps Memorial Health Center 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.