CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Norton-King's Daughters' Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $228
Cash Discount Price: $57
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Norton-King's Daughters' Health is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.02x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $57 (25%)

Insurance Median: $228 (102%)

Cash: $57 (25% of Medicare)

Ins. Median: $228 (102% 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	$29 - $213	13%
Custom Design Benefits	$126 - $426	56%
UnitedHealthcare	$199 - $213	89%
Aetna	$213 - $236	95%
Humana	$213	95%
Cigna	$215 - $228	96%
Encore	$215 - $228	96%
Managed Health Services	$219 - $330	98%
Quality Care Partners	$225 - $239	101%
Bluegrass	$228 - $241	102%
First Health	$228 - $241	102%
Healthlink	$228 - $241	102%
Vha/Tristate	$228 - $241	102%
Multiplan/Phcs	$233 - $247	104%
Indiana Health Network	$240 - $255	107%
Siho	$240 - $255	107%
Caresource Of Kentucky	$298	133%
Caresource Of Indiana	$320	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 $57.
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 Norton-King's Daughters' Health 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.