CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Penn State Health St. Joseph

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $208
Cash Discount Price: $53
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Penn State Health St. Joseph is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.93x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$208

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: $53 (24%)

Insurance Median: $208 (93%)

Cash: $53 (24% of Medicare)

Ins. Median: $208 (93% 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	$52 - $225	23%
[Upmc]	$74 - $227	33%
UnitedHealthcare	$80 - $223	36%
[Cbc]	$92 - $223	41%
[Ibc]	$101 - $223	45%
Cigna	$125	56%
[Geisinger]	$147 - $223	66%
[Preferred Healthcare Systems]	$153	68%
[First Health]	$163	73%
[Multiplan]	$163	73%
[Amerihealth Caritas]	$189 - $223	84%
[Highmark Wholecare]	$189 - $223	84%
[Health Partners Plans]	$207 - $227	93%
[Pa Health & Wellness]	$208 - $229	93%
[Highmark]	$220 - $1,210	98%
Humana	$225	101%
[Healthspring]	$225	101%
[Point Comfort Underwriters]	$278	124%
[Highmark Choice Blue]	$968	433%
[Highmark Aca]	$1,017	455%

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 $53.
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 Penn State Health St. Joseph 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.