CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: West Allis Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $119
Cash Discount Price: $90
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at West Allis Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.53x the Medicare baseline. Located in 8901 W Lincoln Ave, West Allis, WI.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $90 (40%)

Insurance Median: $119 (53%)

Cash: $90 (40% of Medicare)

Ins. Median: $119 (53% 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	$85 - $142	38%
Everpointe Elite	$85 - $95	38%
Hs Technology	$85 - $95	38%
Aetna	$94 - $34,302	42%
Quartz One	$94 - $104	42%
UnitedHealthcare	$101 - $280	45%
Aurora Caregiver	$102 - $114	46%
Blue Cross Blue Shield	$102 - $162	46%
Common Ground	$102 - $114	46%
Health Eos Plus	$102 - $114	46%
Healthpartners	$102 - $142	46%
Molina Exchange	$102 - $114	46%
Quartz Group	$102 - $114	46%
Wisconsin Physician Service	$105 - $124	47%
Health Payment Systems	$110 - $124	49%
Trilogy	$119 - $133	53%
Cigna	$128 - $161	57%
Health Eos	$136 - $152	61%

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 $90.
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 West Allis Memorial Hospital 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.