CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Marshfield Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $116
Cash Discount Price: $120
vs. Medicare Baseline: 0.52x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Marshfield Medical Center is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.52x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$120

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $120 (54%)

Insurance Median: $116 (52%)

Cash: $120 (54% of Medicare)

Ins. Median: $116 (52% 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
Family Health Center (Fhc)	$63	28%
Security Health Plan (Shp)	$64 - $193	29%
Amish/Mennonite	$69	31%
Sanford Health Plan	$69	31%
The Alliance	$88 - $105	39%
Blue Cross Blue Shield	$96 - $199	43%
Group Health Cooperative Of Eau Claire	$103 - $205	46%
Besse Forest Products	$107	48%
Molina Healthcare Of Wi	$107	48%
Rice Lake School District	$107	48%
Wps Health Insurance	$111 - $122	50%
Trilogy	$113 - $121	51%
UnitedHealthcare	$115	51%
Medica Of Wi	$117 - $119	52%
Cigna	$118	53%
Healtheos By Multiplan Inc.	$118 - $120	53%
Corvel	$120	54%
First Health	$120	54%
Health Partners	$120	54%
Three Rivers Provider Network (Trpn)	$120	54%
Coventry	$121	54%
Health Smart	$121	54%
Rising Medical Work Comp	$122	55%
Veteran'S Administration (Va Ccn)	$193	86%

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 $120.
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 Marshfield 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.