CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Kane

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $110
Cash Discount Price: $144
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Kane is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.49x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

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: $144 (64%)

Insurance Median: $110 (49%)

Cash: $144 (64% of Medicare)

Ins. Median: $110 (49% 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
Blue Cross Blue Shield	$37 - $95	17%
UPMC Work Partners	$46	21%
UPMC Health Plan	$49 - $112	22%
Focus Healthcare	$51 - $244	23%
Highmark Wholecare (Prev Gateway)	$85 - $98	38%
Aetna	$86 - $99	38%
UnitedHealthcare	$87 - $126	39%
Amerihealth Caritas	$90 - $103	40%
PA Health & Wellness	$123 - $141	55%
Geisinger	$123 - $141	55%
Horizon Health Plan	$157 - $180	70%
Cigna	$157 - $5,786	70%
Multiplan	$168 - $193	75%
Health Coalition Partners	$179 - $206	80%
Intergroup	$179 - $206	80%

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 $144.
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 Kane 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.