CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Warner Hospital and Health Services

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $261
Cash Discount Price: $384
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Warner Hospital and Health Services is $261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $384. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.17x the Medicare baseline. Located in 422 W White St, Clinton, IL.

Cash / Self-Pay

$384

Average discount available for prompt cash payment at this facility.

Insurance Median

$261

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: $384 (172%)

Insurance Median: $261 (117%)

Cash: $384 (172% of Medicare)

Ins. Median: $261 (117% 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	$61 - $753	27%
Aetna	$63 - $653	28%
Health Alliance Med Adv	$63 - $315	28%
Humana	$63 - $653	28%
Molina Mcr/Mcd Dual	$63 - $315	28%
UnitedHealthcare	$63 - $653	28%
Wellcare Mcr Adv-All Plans	$63 - $315	28%
Healthlink Hmo	$120 - $599	54%
City Of Clinton (Employees Serv)-All Plans	$123 - $614	55%
Cigna	$128 - $637	57%
Caterpillar-All Plans	$131 - $653	59%
Multiplan Phcs-All Plans	$131 - $653	59%
Health Alliance-All Other Plans	$135 - $676	60%
Healthlink Ppo/Work Comp-All Other Plans	$135 - $676	60%
Consociate Care Ppo-All Plans	$138 - $691	62%
Hfn Ppo/Epo-All Plans	$138 - $691	62%
Three Rivers-All Plans	$146 - $730	65%
Harmony Hp Mcaid-All Plans	$218	97%
Medicaid / KanCare	$218	97%
Meridian Hp-All Plans	$218	97%
Molina-All Other Plans	$218	97%

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 $384.
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 Warner Hospital and Health Services 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.