CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Hamot

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $309
Cash Discount Price: $617
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Hamot is $309. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $617. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.38x the Medicare baseline. Located in 201 State Street, Erie, PA.

Cash / Self-Pay

$617

Average discount available for prompt cash payment at this facility.

Insurance Median

$309

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: $617 (276%)

Insurance Median: $309 (138%)

Cash: $617 (276% of Medicare)

Ins. Median: $309 (138% 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
Blue Cross Blue Shield	$25 - $235	11%
Upmc Health Plan	$33 - $228	15%
Upmc Work Partners	$38	17%
Univera	$154 - $453	69%
Fidelis	$224	100%
Aetna	$228 - $720	102%
Wellcare	$230	103%
UnitedHealthcare	$239 - $468	107%
Amerihealth Caritas	$242	108%
Cigna	$242 - $412	108%
Highmark Wholecare (Prev Gateway)	$242 - $514	108%
Pa Health & Wellness	$242 - $566	108%
Geisinger	$566	253%
Intergroup	$669 - $823	299%
Multiplan	$720 - $823	322%

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 $617.
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 Hamot 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.