CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Josephs Community Hospital West Bend

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $156
Cash Discount Price: $100
vs. Medicare Baseline: 0.70x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Josephs Community Hospital West Bend is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.70x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $100 (45%)

Insurance Median: $156 (70%)

Cash: $100 (45% of Medicare)

Ins. Median: $156 (70% 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
Centivo	$38 - $79	17%
UnitedHealthcare	$41 - $661	18%
Froedtert South	$52 - $101	23%
Chorus Community Health Plan	$54 - $103	24%
Common Ground	$75 - $144	34%
Health Payment Systems	$79 - $194	35%
Health Partners	$81 - $198	36%
Aetna	$88 - $201	39%
Wisconsin Physician Services	$100 - $192	45%
Trilogy	$102 - $197	46%
Blue Cross Blue Shield	$106 - $575	47%
Americas Choice	$109 - $209	49%
Healtheos	$109 - $209	49%
Multiplan/Private Healthcare Systems	$109 - $209	49%
First Health Network	$110 - $211	49%
Hfn	$112 - $216	50%
Ibsi Passport	$112 - $216	50%
Cigna	$119 - $228	53%
Healthsmart	$119 - $228	53%
Allwell	$198	89%
Community Care	$198	89%
Humana	$198	89%
Icare	$198	89%
Molina	$198	89%
Network Health Plan	$198 - $444	89%
Security Health Plan Secure Savers	$198	89%
Care Wisconsin	$203	91%
Sheboygan Employers Health Network	$704	315%

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 $100.
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 St Josephs Community Hospital West Bend 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.