CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lecom Medical Center and Behavioral Health Pav

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $294
Cash Discount Price: $294
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lecom Medical Center and Behavioral Health Pav is $294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $294. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.31x the Medicare baseline. Located in 5515 Peach Street, Erie, PA.

Cash / Self-Pay

$294

Average discount available for prompt cash payment at this facility.

Insurance Median

$294

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: $294 (131%)

Insurance Median: $294 (131%)

Cash: $294 (131% of Medicare)

Ins. Median: $294 (131% 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
UnitedHealthcare	$11	5%
Blue Cross Blue Shield	$227 - $320	101%
Healthchoice_Berks	$294	131%
Healthchoice_Blair	$294	131%
Healthchoice_Carbon_Monroe_Pike	$294	131%
Healthchoice_Chester	$294	131%
Healthchoice_Erie	$294	131%
Healthchoice_Lycoming_Clinton	$294	131%
Healthchoice_Northcentral	$294	131%
Healthchoice_Northeast	$294	131%
Healthchoice_Somerset_Bedford	$294	131%
Healthchoice_York_Adams	$294	131%
Medicare (plans)	$294	131%
Upmc_Commercial	$294	131%
Upmc_For_Life	$294	131%
Upmc_For_Life_Hmo_Premier_Rx	$294	131%
Upmc_Partner	$294	131%
Upmc_Value	$294	131%
Upmc_Value_Select	$294	131%
Aetna	$323	144%
Cigna	$405	181%

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 $294.
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 Lecom Medical Center and Behavioral Health Pav 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.