CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Saint Vincent Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $174
Cash Discount Price: $650
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Saint Vincent Hospital is $174. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $650. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.78x the Medicare baseline. Located in 232 West 25Th Street, Erie, PA.

Cash / Self-Pay

$650

Average discount available for prompt cash payment at this facility.

Insurance Median

$174

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: $650 (291%)

Insurance Median: $174 (78%)

Cash: $650 (291% of Medicare)

Ins. Median: $174 (78% 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
Univera	$6 - $10	3%
Highmark	$9 - $323	4%
Cigna	$12 - $472	5%
UnitedHealthcare	$31 - $5,977	14%
Martin'S Point	$42 - $221	19%
University Of Pittsburgh Medical Center	$45 - $221	20%
American Health Plans	$221	99%
Life Pittsburgh	$221	99%
Medicare (plans)	$228	102%
Aetna	$230 - $451	103%
Amerihealth	$232	104%
Blue Cross Blue Shield	$232 - $349	104%
Highmark Wholecare	$235	105%
Humana	$235	105%
Molina	$241	108%
Medical Mutual	$472	211%

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 $650.
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 Saint Vincent 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.