CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Upland Hills Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $176
Cash Discount Price: $141
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Upland Hills Health is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.79x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$176

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: $141 (63%)

Insurance Median: $176 (79%)

Cash: $141 (63% of Medicare)

Ins. Median: $176 (79% 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
UnitedHealthcare	$7 - $20	3%
Quartz	$44	20%
Blue Cross Blue Shield	$71 - $391	32%
Humana	$71 - $429	32%
Icare	$71 - $133	32%
Medical Associates	$71 - $357	32%
Mhs	$71 - $133	32%
Security Health Plan	$71 - $133	32%
Ghc Of Eau Claire	$86	38%
Ghc Of Sc Wi	$86 - $324	38%
Alliance	$143 - $269	64%
Wps	$155 - $300	69%
Dean Health Plan	$176 - $331	79%
Cigna	$189 - $397	84%
Multiplan	$223 - $419	100%

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 $141.
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 Upland Hills Health 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.