CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Childrens Hospital of Wisconsin

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $138
Cash Discount Price: $80
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Childrens Hospital of Wisconsin is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.62x the Medicare baseline. Located in 9000 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $80 (36%)

Insurance Median: $138 (62%)

Cash: $80 (36% of Medicare)

Ins. Median: $138 (62% 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
Froedtert Health	$40 - $169	18%
Medical College Of Wisconsin	$40 - $139	18%
Network Health Plan	$41 - $142	18%
UnitedHealthcare	$42 - $147	19%
Aspirus Health Plan	$43 - $149	19%
Common Ground Healthcare Cooperative	$43 - $169	19%
Trilogy Health Solutions	$43 - $169	19%
Wps Health Plan	$43 - $179	19%
Advocate Aurora Healthcare	$44 - $153	20%
Blue Cross Blue Shield	$44 - $189	20%
Centivo	$44 - $155	20%
Health Partners	$44 - $175	20%
Employer Health Care Alliance Cooperative	$45 - $156	20%
Dean Health Plan	$46 - $159	21%
Group Health Cooperative Of Eau Claire	$46 - $159	21%
Oan Llc	$46 - $159	21%
Security Health Plan	$47 - $165	21%
Health Payment Systems	$48 - $169	21%
Praire States	$48 - $169	21%
Quartz Health Insurance	$48 - $169	21%
Sheboygan Employer'S Health Network	$48 - $169	21%
Aetna	$50 - $177	22%
Mayo Clinic Health Solutions	$50 - $173	22%
Bellin Thedacare	$51 - $179	23%
Cigna	$51 - $179	23%
Group Health Cooperative Of South Central Wisconsin	$51 - $179	23%
Prevea Health Network	$51 - $179	23%
Multiplan	$52 - $189	23%
Coventry Health Care	$54 - $189	24%

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 $80.
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 Childrens Hospital of Wisconsin 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.