CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mc Donough District Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $179
Cash Discount Price: $127
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mc Donough District Hospital is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.80x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $127 (57%)

Insurance Median: $179 (80%)

Cash: $127 (57% of Medicare)

Ins. Median: $179 (80% 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
Health Alliance	$4 - $227	2%
Aetna	$7 - $227	3%
Humana	$7 - $227	3%
Medicaid / KanCare	$7 - $211	3%
Medicare (plans)	$7 - $227	3%
Meridian	$7 - $227	3%
Molina	$7 - $211	3%
Mutual Medical	$7 - $211	3%
UnitedHealthcare	$7 - $227	3%
Veteran Affairs	$7 - $227	3%
Hfn	$8 - $190	4%
Blue Cross Blue Shield	$72 - $211	32%
Springfield Health	$173	77%
Consociate	$179	80%
Trilogy	$179	80%
Blue Choice	$190	85%
Current Health	$190	85%
Healthlink	$190 - $198	85%
Preferred Plan	$200	89%
Tricare	$212	95%

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 $127.
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 Mc Donough District 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.