CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Unitypoint Health - Meriter

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $278
Cash Discount Price: $619
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Unitypoint Health - Meriter is $278. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $619. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.24x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$619

Average discount available for prompt cash payment at this facility.

Insurance Median

$278

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: $619 (277%)

Insurance Median: $278 (124%)

Cash: $619 (277% of Medicare)

Ins. Median: $278 (124% 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
Aspirus	$7 - $541	3%
Blue Cross Blue Shield	$7 - $857	3%
Illinicare	$7 - $196	3%
Prevea 360	$7 - $767	3%
UnitedHealthcare	$7 - $373	3%
Humana	$8 - $196	4%
Meridiancare	$8 - $196	4%
Wellmark Uph Self-Funded	$22 - $521	10%
Medical Associates Health Plan	$31 - $325	14%
Health Partners Open Network	$32 - $329	14%
Cigna	$34 - $271	15%
Security Health Plan	$37 - $280	17%
Mercy Care	$43 - $299	19%
Quartz	$241 - $281	108%

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 $619.
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 Unitypoint Health - Meriter 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.