CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Hamilton Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $50
  • Cash Discount Price: $84
  • vs. Medicare Baseline: 0.22x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hamilton Memorial Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.22x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.
Cash / Self-Pay
$84

Average discount available for prompt cash payment at this facility.

Insurance Median
$50

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: $84 (38%)
Insurance Median: $50 (22%)
Cash: $84 (38% of Medicare)
Ins. Median: $50 (22% 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
Aetna $8 - $136 4%
Blue Cross Blue Shield $8 - $138 4%
Health Alliance $8 - $121 4%
Medicare (plans) $8 - $60 4%
UnitedHealthcare $8 - $108 4%
Wellcare $8 - $60 4%
Medicaid / KanCare $20 - $60 9%
Humana $21 - $60 9%
Alliance Coal $37 - $106 17%
Healthscope $37 - $106 17%
Wellfirst (Ssmhic) $37 - $106 17%
Hope Trust $39 - $113 17%
Cigna $41 - $119 18%
Hfn, Inc $42 - $136 19%
Healthlink $45 - $136 20%
Multiplan $45 - $129 20%
Siho $47 - $136 21%
Three Rivers Provider $47 - $136 21%
Healthsmart $50 - $144 22%
Stratose $50 - $144 22%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 611 S Marshall Avenue, McLeansboro, IL 62859
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals