CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $13
Cash Discount Price: $354
vs. Medicare Baseline: 0.06x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at The University of Vermont Health Network-Alice Hy is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $354. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.06x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$354

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

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: $354 (158%)

Insurance Median: $13 (6%)

Cash: $354 (158% of Medicare)

Ins. Median: $13 (6% 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
Capital District Physicians' Health Plan	$5 - $333	2%
UnitedHealthcare	$5 - $349	2%
Fidelis Care	$6 - $113	3%
Humana	$6 - $113	3%
Mvp	$6 - $113	3%
Aetna	$7 - $304	3%
Martins Point	$7 - $113	3%
Veterans Affairs Community Care Network	$7 - $113	3%
Blue Cross Blue Shield	$9 - $658	4%
Choicecare	$9 - $266	4%
St. Regis	$113 - $446	51%
Magnacare	$283	126%
Highmark Blueshield	$317 - $347	142%

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 $354.
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 The University of Vermont Health Network-Alice Hy 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.