CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Fayette County Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $73
Cash Discount Price: $147
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Fayette County Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.33x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $147 (66%)

Insurance Median: $73 (33%)

Cash: $147 (66% of Medicare)

Ins. Median: $73 (33% 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
Aetna	$8 - $158	4%
Health Alliance Mcare	$8 - $73	4%
Healthlink Mcr Adv	$8 - $73	4%
Coventry/Ghp-All Plans	$11 - $149	5%
Cigna	$12 - $172	5%
Multiplan - All Plans	$15 - $195	7%
Health Alliance - All Other Plans	$16 - $189	7%
Blue Cross Blue Shield	$22 - $192	10%
Illinicare - All Plans	$53 - $113	24%
Medicaid / KanCare	$53 - $113	24%
Meridian-All Plans	$53 - $113	24%
UnitedHealthcare	$54 - $190	24%
Healthlink Hmo	$55 - $160	25%
Healthlink Ppo - All Other Plans	$55 - $183	25%
Humana	$73	33%

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 $147.
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 Fayette County 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.