CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Wabash General Hospital 1

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $36
Cash Discount Price: $64
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Wabash General Hospital 1 is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.16x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $64 (29%)

Insurance Median: $36 (16%)

Cash: $64 (29% of Medicare)

Ins. Median: $36 (16% 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	$12 - $139	5%
Health Alliance Mcr Adv - All Plans	$13 - $27	6%
UnitedHealthcare	$13 - $69	6%
Aetna	$28 - $139	13%
Healthlink Hmo	$29 - $60	13%
Cigna	$31 - $65	14%
Encore Combined Ip/Op Only	$31 - $65	14%
Hope Trust - All Plans	$31 - $65	14%
Healthlink Ppo - All Other Plans	$33 - $69	15%
Phcs - All Plans	$33 - $69	15%
Health Smart - All Plans	$36 - $73	16%
Hfn - All Plans	$36 - $73	16%
Multiplan - All Plans	$36 - $73	16%
Siho Network - All Plans	$36 - $73	16%
Encore Health Network Ip/Op Only - All Other Plans	$38 - $78	17%
Meridian Mcaid - All Plans	$139	62%
Molina Mcaid - All Plans	$139	62%

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 $64.
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 Wabash General Hospital 1 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.