CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Pinckneyville Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $399
Cash Discount Price: $700
vs. Medicare Baseline: 1.78x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Pinckneyville Community Hospital is $399. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $700. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.78x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$700

Average discount available for prompt cash payment at this facility.

Insurance Median

$399

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: $700 (313%)

Insurance Median: $399 (178%)

Cash: $700 (313% of Medicare)

Ins. Median: $399 (178% 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
Humana	$182 - $364	81%
Umwa Mcr Adv - All Plans	$182 - $364	81%
UnitedHealthcare	$182 - $806	81%
Wellcare Mcr Adv - All Plans	$182 - $364	81%
Aetna	$186 - $885	83%
Ambetter / Centene	$314	140%
Blue Cross Blue Shield	$314 - $708	140%
Medicaid / KanCare	$314	140%
Healthlink Hmo	$387 - $772	173%
Phcs - All Other Plans	$404 - $806	181%
Cigna	$407 - $811	182%
Healthlink Ppo - All Other Plans	$407 - $811	182%
Healthlink Work Comp	$407 - $811	182%
Phcs Savility	$419 - $836	187%
Multiplan - All Plans	$444 - $885	198%

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 $700.
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 Pinckneyville Community 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.