CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Northwest

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $81
Cash Discount Price: $74
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Northwest is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.36x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $74 (33%)

Insurance Median: $81 (36%)

Cash: $74 (33% of Medicare)

Ins. Median: $81 (36% 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
Aetna	$31 - $204	14%
Upmc Work Partners	$35	16%
Cigna	$50 - $81	22%
Highmark Wholecare (Prev Gateway)	$62 - $209	28%
Blue Cross Blue Shield	$64 - $194	29%
Pa Health & Wellness	$68 - $209	30%
Upmc Health Plan	$80 - $199	36%
Intergroup	$81 - $3,704	36%
Coventry/First Health	$87	39%
Health Coalition Partners	$89	40%
Private Health Care Systems	$99	44%
Humana	$105	47%
UnitedHealthcare	$204 - $213	91%
Amerihealth Caritas	$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 $74.
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 Northwest 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.