CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Williamsport

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $200
Cash Discount Price: $193
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Williamsport is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.89x the Medicare baseline. Located in 700 High Street, Williamsport, PA.

Cash / Self-Pay

$193

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

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: $193 (86%)

Insurance Median: $200 (89%)

Cash: $193 (86% of Medicare)

Ins. Median: $200 (89% 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
Upmc Work Partners	$38	17%
Three Rivers Provider Network	$41 - $430	18%
Multiplan	$42 - $373	19%
Aetna	$87 - $315	39%
Blue Cross Blue Shield	$98 - $224	44%
Upmc Health Plan	$108 - $208	48%
Coventry/First Health	$124 - $322	55%
Pa Health & Wellness	$136 - $263	61%
Wirerope Works	$137 - $266	61%
UnitedHealthcare	$150 - $327	67%
Geisinger	$165 - $320	74%
Cigna	$169 - $327	76%
America'S Choice	$198 - $382	89%
Intergroup	$198 - $382	89%
Amerihealth Caritas	$200	89%
Highmark Wholecare (Prev Gateway)	$209	93%

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 $193.
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 UPMC Williamsport 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.