CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ira Davenport Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $235
Cash Discount Price: $71
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ira Davenport Memorial Hospital is $235. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.05x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$235

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: $71 (32%)

Insurance Median: $235 (105%)

Cash: $71 (32% of Medicare)

Ins. Median: $235 (105% 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
Empire	$7 - $8	3%
Blue Cross Blue Shield	$20 - $1,387	9%
Fidelis Care - Exchange - All Plans	$25 - $251	11%
Geisinger - All Plans	$27 - $266	12%
Cigna	$29 - $285	13%
Mvp Health Plan - All Plans	$29 - $285	13%
Independent Health - All Plans	$30 - $297	13%
Upmc - All Plans	$32 - $315	14%
Pomco Inc - All Plans	$33 - $329	15%
Aetna	$34 - $408	15%
UnitedHealthcare	$34 - $480	15%
Emblem Health - All Plans	$40 - $402	18%
Humana	$41 - $411	18%
Emblem/Ghi	$42 - $422	19%
Martins Point - All Plans	$46 - $457	21%
Healthnow - All Plans	$151 - $1,506	67%
Fidelis	$235	105%
Tricare	$241	108%
Amerihealth Caritas Mcr Adv - All Plans	$243	109%

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 $71.
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 Ira Davenport 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.