CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Bedford Memorial

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $66
Cash Discount Price: $59
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Bedford Memorial is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.30x the Medicare baseline. Located in 10455 Lincoln Highway, Everett, PA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $59 (26%)

Insurance Median: $66 (30%)

Cash: $59 (26% of Medicare)

Ins. Median: $66 (30% 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	$25 - $200	11%
Cigna	$40 - $209	18%
Upmc Work Partners	$46	21%
Highmark Wholecare (Prev Gateway)	$50 - $209	22%
Geisinger	$54	24%
Pa Health & Wellness	$54 - $209	24%
UnitedHealthcare	$54 - $207	24%
Intergroup	$64 - $89	29%
Upmc Health Plan	$66 - $200	30%
Blue Cross Blue Shield	$68 - $194	30%
Coventry/First Health	$69	31%
Preferred Healthcare System	$79	35%
Health Coalition Partners	$89	40%
Humana	$89	40%
Private Health Care Systems	$89	40%
Selectcare	$89	40%
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 $59.
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 Bedford Memorial 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.