CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Elkhart General Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $180
Cash Discount Price: $161
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Elkhart General Hospital is $180. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.80x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$180

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: $161 (72%)

Insurance Median: $180 (80%)

Cash: $161 (72% of Medicare)

Ins. Median: $180 (80% 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
Devoted Healthcare	$49 - $224	22%
Blue Cross Blue Shield	$52 - $636	23%
Aetna	$111 - $213	50%
Mclaren (Mi	$114	51%
UnitedHealthcare	$114 - $213	51%
Cha	$148 - $193	66%
Immergrun	$148 - $198	66%
Mhs	$161 - $384	72%
Php	$161 - $173	72%
Humana	$170 - $213	76%
Cigna	$178 - $188	80%
Multiplan	$178	80%
Signature	$180	80%
Encore	$183	82%
Plain Church	$198 - $320	89%
Pace	$213	95%
Heartland	$247	110%
Caresource	$321 - $341	143%
Mdwise	$321	143%

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 $161.
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 Elkhart General 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.