CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Highland Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $15
  • Cash Discount Price: $213
  • vs. Medicare Baseline: 0.07x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Highland Hospital is $15. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.07x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.
Cash / Self-Pay
$213

Average discount available for prompt cash payment at this facility.

Insurance Median
$15

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: $213 (95%)
Insurance Median: $15 (7%)
Cash: $213 (95% of Medicare)
Ins. Median: $15 (7% 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.

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
Amerigroup (Bswny Alternate) [1720] $3 1%
Excellus [2201] $3 1%
Medicaid / KanCare $3 - $15 1%
Molina Healthcare [5189], Molina Healthcare [1723] $3 1%
Mvp [2900] $3 - $679 1%
UnitedHealthcare $3 - $282 1%
Aetna $6 - $313 3%
Excellus Bc/Bs [2201] $6 - $14 3%
Medicare (plans) $6 - $333 3%
Elderplan [1316] $7 3%
Fidelis [5155] $7 - $23 3%
Humana $7 - $308 3%
Icircle [1728] $7 3%
Martins Point [1205] $7 - $273 3%
Nascentia [1729] $7 3%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401] $8 - $25 4%
Highmark Bc/Bs Of Western Ny [5143] $16 - $20 7%
Cigna $18 - $751 8%
Capital District Physicians Health Plan (Cdphp) [5149] $22 - $29 10%
Independent Health [5156] $26 - $32 12%
Blue Cross Blue Shield $273 - $390 122%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 South Avenue, Rochester, NY 14617
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals