CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Childrens Hospital of Wisconsin Fox Valley

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $90
Cash Discount Price: $62
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Childrens Hospital of Wisconsin Fox Valley is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.40x the Medicare baseline. Located in 130 Second St, Neenah, WI.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $62 (28%)

Insurance Median: $90 (40%)

Cash: $62 (28% of Medicare)

Ins. Median: $90 (40% 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	$59 - $103	26%
Medical College Of Wisconsin	$59 - $85	26%
Network Health Plan	$60 - $87	27%
UnitedHealthcare	$62 - $89	28%
Aspirus Health Plan	$63 - $91	28%
Common Ground Healthcare Cooperative	$63 - $103	28%
Trilogy Health Solutions	$63 - $103	28%
Wps Health Plan	$64 - $110	29%
Advocate Aurora Healthcare	$65 - $94	29%
Blue Cross Blue Shield	$66 - $116	30%
Centivo	$66 - $95	30%
Employer Health Care Alliance Cooperative	$66 - $96	30%
Health Partners	$66 - $107	30%
Dean Health Plan	$67 - $97	30%
Group Health Cooperative Of Eau Claire	$67 - $97	30%
Oan Llc	$67 - $97	30%
Security Health Plan	$70 - $101	31%
Health Payment Systems	$71 - $103	32%
Praire States	$71 - $103	32%
Quartz Health Insurance	$71 - $103	32%
Sheboygan Employer'S Health Network	$71 - $103	32%
America'S Ppo	$73 - $106	33%
Aetna	$74 - $108	33%
Bellin Thedacare	$76 - $110	34%
Cigna	$76 - $110	34%
Group Health Cooperative Of South Central Wisconsin	$76 - $110	34%
Healthsmart	$76 - $110	34%
Multiplan	$76 - $116	34%
Prevea Health Network	$76 - $110	34%
Coventry Health Care	$80 - $116	36%

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 $62.
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 Fox Valley 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.