CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Hanover

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $387
Cash Discount Price: $418
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Hanover is $387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $418. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.73x the Medicare baseline. Located in 300 Highland Ave, Hanover, PA.

Cash / Self-Pay

$418

Average discount available for prompt cash payment at this facility.

Insurance Median

$387

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: $418 (187%)

Insurance Median: $387 (173%)

Cash: $418 (187% of Medicare)

Ins. Median: $387 (173% 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 Work Partners	$36	16%
Upmc Health Plan	$66 - $488	30%
Blue Cross Blue Shield	$132 - $691	59%
Keystone Health Plan	$132 - $474	59%
UnitedHealthcare	$153 - $613	68%
Prime Net	$169 - $217	76%
Humana	$194	87%
Aetna	$203 - $507	91%
Cigna	$204 - $544	91%
Geisinger	$204 - $503	91%
Pa Health & Wellness	$210 - $383	94%
Keystone Autism Services	$311	139%
Carefirst	$592	265%
Multiplan	$592	265%
Wellspan Population Health	$606	271%

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 $418.
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 Hanover 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.