CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Greene

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $113
Cash Discount Price: $73
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Greene is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.51x the Medicare baseline. Located in 350 Bonar Avenue, Waynesburg, PA.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

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: $73 (33%)

Insurance Median: $113 (51%)

Cash: $73 (33% of Medicare)

Ins. Median: $113 (51% 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 - $417	11%
UnitedHealthcare	$48 - $54	21%
Highmark Wholecare (Prev Gateway)	$51 - $155	23%
Senior Life	$72 - $194	32%
Blue Cross Blue Shield	$180 - $386	80%
Upmc Health Plan	$194	87%
Humana	$196	88%
City Of Washington	$388	173%

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 $73.
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 Greene 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.