CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Memorial Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $429
Cash Discount Price: $715
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Memorial Medical Center is $429. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $715. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.92x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$715

Average discount available for prompt cash payment at this facility.

Insurance Median

$429

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: $715 (320%)

Insurance Median: $429 (192%)

Cash: $715 (320% of Medicare)

Ins. Median: $429 (192% 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
Blue Cross Blue Shield	$8 - $715	4%
Medicaid / KanCare	$72	32%
Molina	$74	33%
Veterans Administration	$166	74%
Health Alliance	$229 - $826	102%
Aetna	$231 - $543	103%
Medicare (plans)	$231 - $715	103%
Tricare	$231	103%
UnitedHealthcare	$231 - $443	103%
Humana	$242 - $429	108%
Current Health Network Ppo	$322	144%
Healthlink	$358 - $450	160%
Commercial Workers Compensation	$361	161%
Cigna	$375	168%
Illinois Workers Compensation	$380	170%
Phcs/Multiplan	$386 - $429	173%
6 Degrees Health	$429	192%
Hopetrust	$429	192%
Hst	$429	192%
Magellan	$429	192%
Consociate	$465	208%
Hfn	$465	208%
Preferred Plan	$536	240%
Soi Mcfarland	$536	240%
Soi Rushville	$536	240%
Corvel	$572	256%
Methodist First Choice	$572	256%
Mutual Medical Plans	$608	272%
Liability	$715	320%

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 $715.
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 Memorial Medical Center 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.