CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $130
Cash Discount Price: $142
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UPMC Children's Hospital of Pittsburgh is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.58x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $142 (63%)

Insurance Median: $130 (58%)

Cash: $142 (63% of Medicare)

Ins. Median: $130 (58% 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
Aetna	$11 - $213	5%
Upmc Health Plan	$66 - $82	30%
Blue Cross Blue Shield	$70 - $206	31%
UnitedHealthcare	$92 - $464	41%
Geisinger	$103 - $134	46%
Cigna	$108 - $209	48%
Health Plan Of Upper Ohio Valley	$149 - $194	67%
Intergroup	$149 - $207	67%
Coventry/First Health	$183 - $194	82%
Saudi Armed Forces	$183 - $194	82%
Health Payors Organization	$195 - $207	87%
Multiplan	$195 - $207	87%
National Provider Network	$206 - $219	92%
Private Health Care Systems	$206 - $219	92%
Amerihealth Caritas	$209	93%

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 $142.
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 Children's Hospital of Pittsburgh 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.