CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Anderson Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $231
  • Cash Discount Price: $165
  • vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Anderson Hospital is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.03x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.
Cash / Self-Pay
$165

Average discount available for prompt cash payment at this facility.

Insurance Median
$231

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: $165 (74%)
Insurance Median: $231 (103%)
Cash: $165 (74% of Medicare)
Ins. Median: $231 (103% 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
Tricare $7 - $5,703 3%
Humana $8 - $4,783 4%
Medicare (plans) $8 - $4,783 4%
UnitedHealthcare $8 - $4,783 4%
Health Care Service Corporation $11 - $151 5%
Medicaid / KanCare $14 - $72 6%
Work Comp $34 - $26,600 15%
Self Pay $165 - $25,000 74%
Blue Cross Blue Shield $177 - $184 79%
Aetna $195 - $4,783 87%
Healthlink $205 - $231 92%
Mercy Aco $215 96%
Mercy Benefit Admin $215 96%
Cigna $231 103%
Essence $235 - $5,026 105%
Devoted Health Ppo $236 - $4,878 105%
Clear Springs Health $238 - $4,926 106%
Multiplan/Phcs $248 111%
Beech Street Corporation $297 133%
Ambetter / Centene $340 - $7,075 152%
Blue Choice $340 - $7,075 152%
Hopetrust $587 - $12,198 262%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 6800 State Route 162, Maryville, IL 62062
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals