CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Holy Family Memorial

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $152
Cash Discount Price: $105
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Holy Family Memorial is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.68x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $105 (47%)

Insurance Median: $152 (68%)

Cash: $105 (47% of Medicare)

Ins. Median: $152 (68% 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
Medical College Of Wisconsin	$63	28%
Centivo	$76 - $87	34%
Dean Health Plan	$95	42%
Network Health Plan	$104 - $193	46%
Health Payment Systems	$107	48%
Sheboygan Employers Health Network	$114	51%
Chorus Community Health Plan	$122	55%
Health Partners	$124 - $193	55%
Trilogy	$125	56%
Cigna	$137	61%
Wps Health Plan	$141	63%
Aspirus	$152	68%
Healtheos	$152	68%
Multiplan/Private Healthcare Systems	$152	68%
Preferred One	$152	68%
Security Health Plan	$152 - $193	68%
Healthsmart	$158	71%
First Health Network	$167	75%
Blue Cross Blue Shield	$193 - $572	86%
Community Care Incorporated	$193	86%
Humana	$193	86%
Icare	$193	86%
Molina	$193 - $209	86%
UnitedHealthcare	$193 - $661	86%
Allwell	$197	88%

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 $105.
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 Holy Family Memorial 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.