CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Goshen Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $196
Cash Discount Price: $425
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Goshen Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $425. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.88x the Medicare baseline. Located in 200 High Park Ave, Goshen, IN.

Cash / Self-Pay

$425

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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: $425 (190%)

Insurance Median: $196 (88%)

Cash: $425 (190% of Medicare)

Ins. Median: $196 (88% 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
Advantage Health Solutions	$196	88%
Aetna	$196	88%
Atrio Health Plans	$196	88%
Bc Federal Employee	$196	88%
Bc Mcr Advantage Ppo	$196	88%
Blue Cross Blue Shield	$196 - $665	88%
Buckeye Health Plan	$196	88%
Cigna	$196	88%
Coventry Health And Life	$196	88%
Emblem Health	$196	88%
Freedom Healthcare	$196	88%
Geisinger Health Plan	$196	88%
Health First	$196	88%
Healthspring	$196	88%
Humana	$196	88%
Iehp Empire Health Plan	$196	88%
Independent Care Health Plan	$196	88%
Kaiser Permanente	$196	88%
Mcr Advantra Freedom	$196	88%
Mcr Allwell Mhs	$196	88%
Mcr Banner Health	$196	88%
Mcr Complete	$196	88%
Mcr Complete Ppo	$196	88%
Mcr Complete Wellmed	$196	88%
Mcr Health Alliance	$196	88%
Mcr Health Partners Plans	$196	88%
Mcr Medical Mutual Of Ohio	$196	88%
Mcr Passport Advantage	$196	88%
Mcr Secure Horizons Ppo	$196	88%
Mcr Texan Plus	$196	88%
Mcr Upmc For Life	$196	88%
Medicare (plans)	$196 - $208	88%
Meridian Complete	$196	88%
Optimum Healthcare	$196	88%
Paramount Elite	$196	88%
Primetime Health Plan	$196	88%
Simply Complete Hmo	$196	88%
The Umwa H&R Funds	$196	88%
Todays Options Pyramid Life	$196	88%
Trillium Advantage	$196	88%
Ucare For Seniors	$196	88%
Ucare Minnesota	$196	88%
UnitedHealthcare	$196	88%
Wellcare	$196	88%
Champva	$202	90%
Tricare	$202	90%
Mcr Devoted Health Plan	$208	93%
Mcr Provider Partners Hlth Pln	$222	99%
Ambetter / Centene	$283	126%
Mkt Caresource	$283	126%
Bc Allied	$665	297%

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 $425.
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 Goshen 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.