CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Presence Saints Mary and Elizabeth Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $234
Cash Discount Price: $233
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Presence Saints Mary and Elizabeth Medical Center is $234. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $233. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.05x the Medicare baseline. Located in 2233 W Division St, Chicago, IL.

Cash / Self-Pay

$233

Average discount available for prompt cash payment at this facility.

Insurance Median

$234

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: $233 (104%)

Insurance Median: $234 (105%)

Cash: $233 (104% of Medicare)

Ins. Median: $234 (105% 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
Ravenswood Physicians Associates Ipa	$9 - $234	4%
Resurrection Physicians Provider Group Ipa	$9	4%
Aetna	$72 - $245	32%
Blue Cross Blue Shield	$72 - $327	32%
Humana	$72 - $257	32%
Medicaid / KanCare	$72	32%
County Care	$76	34%
Meridian	$76 - $245	34%
Molina	$76 - $350	34%
Imagine Health Network, Inc	$149	67%
Celtic (Wellcare)	$234	105%
Cigna	$234	105%
Clear Spring Health Of Illinois	$234	105%
Devoted Health	$234	105%
Essential Health Partners	$234 - $269	105%
Illini Care	$234	105%
Illinois Physicians Alliance	$234	105%
Longevity Health Plan Of Illinois	$234	105%
Medicare (plans)	$234	105%
Self Pay	$234	105%
Tricare	$234	105%
United Behavioral	$234	105%
UnitedHealthcare	$234 - $443	105%
Zing Health Provider Network	$241	108%
Provider Partners Health Plan (Pphp)	$245	110%
Access Community Health Network	$280	125%
Clifton Health Systems	$362	162%
Ambetter / Centene	$378	169%

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 $233.
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 Presence Saints Mary and Elizabeth 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.