CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Jones Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $11
Cash Discount Price: $316
vs. Medicare Baseline: 0.05x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Jones Memorial Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $316. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.05x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

$316

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $316 (141%)

Insurance Median: $11 (5%)

Cash: $316 (141% of Medicare)

Ins. Median: $11 (5% 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
Fidelis 5155	$3 - $15	1%
Medicaid / KanCare	$3 - $14	1%
Molina Healthcare 1723	$3 - $7	1%
Blue Cross Blue Shield	$3 - $571	1%
Univera Healthcare 1706	$3	1%
UnitedHealthcare	$3 - $293	1%
Excellus 2201	$6 - $11	3%
Aetna	$6 - $310	3%
Independent Health 5156	$7 - $9	3%
Medicare (plans)	$8 - $322	4%
Mvp 2900	$13 - $691	6%
Cigna	$21 - $716	9%
Capital District Physicians Health Plan (Cdphp) 5149	$22	10%
UPMC Health Plan 5138	$220	98%
Humana	$293	131%
Total Senior Care 1319	$293	131%
Empire Plan 5179	$518	232%

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 $316.
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 Jones Memorial 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.