CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mt Sinai Hospital Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $142
  • Cash Discount Price: $79
  • vs. Medicare Baseline: 0.63x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mt Sinai Hospital Medical Center is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.63x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.
Cash / Self-Pay
$79

Average discount available for prompt cash payment at this facility.

Insurance Median
$142

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: $79 (35%)
Insurance Median: $142 (63%)
Cash: $79 (35% of Medicare)
Ins. Median: $142 (63% 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.

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
Partners In Hlth - All Plans $9 - $81 4%
Blue Cross Blue Shield $10 - $235 4%
Compsych Ip/Op Only - All Plans $14 - $122 6%
Healthlink Hmo $15 - $132 7%
Hfn Platinum $15 - $132 7%
Healthlink Ppo - All Other Plans $16 - $142 7%
Multiplan Primary Ntwrk/Phcs - All Other Plans $16 - $142 7%
Hfn Epo $18 - $162 8%
Multiplan Complementary Ntwrk $18 - $162 8%
Hfn Ppo - All Other Plans $20 - $178 9%
Ambetter / Centene $24 - $258 11%
Oscar - All Plans $25 - $223 11%
Cigna $28 - $1,252 13%
Aetna $52 - $458 23%
Humana $72 - $636 32%
Family Health Network Mcaid - All Plans $82 37%
Molina Mcaid $86 38%
UnitedHealthcare $196 - $235 88%
Tricare $228 102%
Va Healthnet - All Plans $228 102%
Advocate Physician Prtnrs Mcr $235 105%
Cenpatico Illinicare Dual $235 105%
Cenpatico Illinicare Mcr - All Other Plans $235 105%
Lawndale Christian - All Plans $235 105%
Meridian/Harmony D-Snp - All Plans $235 105%
Nextlevel Hlth Icp Fhp Aca - All Plans $235 105%
Harmony Behavioral Htlh - All Plans $242 108%
Zing Mcr Adv - All Plans $244 109%
Molina Mcr - All Other Plans $246 110%
Advocate Physician Prtnrs - All Other Plans $258 115%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15Th Street at California, Chicago, IL 60608
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals