CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $155
Cash Discount Price: $114
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Independence Health System Butler Memorial Hospita is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.69x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $114 (51%)

Insurance Median: $155 (69%)

Cash: $114 (51% of Medicare)

Ins. Median: $155 (69% 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
Upmc	$12 - $276	5%
Highmark	$30 - $413	13%
Highmark - Ind.& Managed Care	$30 - $459	13%
Highmark Aca - Direct Blue	$30 - $258	13%
Highmark Community Blue	$30 - $405	13%
Pnoa	$48 - $215	21%
Ccbh - Behavioral Health	$49 - $82	22%
Ellwood Group	$49 - $391	22%
Martin'S Point - Usfhp	$57 - $196	25%
Devoted Health Plan	$65 - $207	29%
Aetna	$82 - $450	37%
Cigna	$82 - $447	37%
Peak Health	$114 - $460	51%
Private Healthcare Systems	$114 - $139	51%
Devon	$122	55%
Intergroup	$130	58%
Multiplan	$147	66%
Geisinger	$163 - $205	73%
Gateway	$171 - $220	76%
Workers Comp	$195	87%
Life Butler County	$196	88%
Medicare (plans)	$196	88%
Provider Partners	$196	88%
Tricare	$196	88%
UnitedHealthcare	$196 - $502	88%
Humana	$204	91%
Amerihealth	$205	92%
The Health Plan	$207 - $460	93%
Pa Health & Wellness	$209	93%
American Health Plan	$215	96%

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 $114.
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 Independence Health System Butler Memorial Hospita 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.