CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Penn State Health Lancaster Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $204
Cash Discount Price: $59
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Penn State Health Lancaster Medical Center is $204. 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 0.91x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $204 (91%)

Cash: $59 (26% of Medicare)

Ins. Median: $204 (91% 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]	$74 - $219	33%
UnitedHealthcare	$77 - $215	34%
[Cbc]	$87 - $215	39%
Aetna	$121 - $217	54%
Cigna	$125	56%
[Geisinger]	$136 - $215	61%
[First Health]	$163	73%
[Multiplan]	$163	73%
[Amerihealth Caritas]	$183 - $215	82%
[Highmark Wholecare]	$183 - $215	82%
[Health Partners Plans]	$200 - $219	89%
[Pa Health & Wellness]	$201 - $221	90%
[Highmark]	$213 - $939	95%
Humana	$217	97%
[Healthspring]	$217	97%
[Point Comfort Underwriters]	$269	120%
[Highmark Choice Blue]	$751	336%
[Highmark Aca]	$789	353%

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 Penn State Health Lancaster Medical Center 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.