CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $126
- Cash Discount Price: $91
- vs. Medicare Baseline: 0.56x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Saint Joseph Regional Medical Center - Plymouth is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.56x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$91
Average discount available for prompt cash payment at this facility.
Insurance Median
$126
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: $91 (41%)
Insurance Median: $126 (56%)
Cash: $91 (41% of Medicare)
Ins. Median: $126 (56% 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
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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 | $25 - $818 | 11% |
| Managed Health Services - Indiana | $25 | 11% |
| Mdwise | $25 | 11% |
| Medicaid / KanCare | $25 - $120 | 11% |
| UnitedHealthcare | $25 - $232 | 11% |
| Plain Church Group | $38 | 17% |
| Notre Dame Athletic Association | $77 | 34% |
| Wc Notre Dame | $77 | 34% |
| Luminare Health (Detroit) | $80 - $84 | 36% |
| Ameriben | $84 | 38% |
| Auxiant | $88 - $498 | 39% |
| Geha | $89 | 40% |
| Healthscope | $89 | 40% |
| Student Insurance Cma | $89 | 40% |
| Aetna | $91 - $359 | 41% |
| Allied Benefit Systems | $91 - $440 | 41% |
| Asr Health Benefits | $91 | 41% |
| Christian Brother Services | $91 | 41% |
| Employee Benefit Management | $91 | 41% |
| Medical Mutual | $91 | 41% |
| Meritain | $91 | 41% |
| Preferred One | $91 | 41% |
| Rural Carrier Health Benefit Plan | $91 | 41% |
| Webtpa | $91 | 41% |
| Encore Health | $98 | 44% |
| Indiana Criminal Justice Inst | $98 | 44% |
| Key Benefit Administrator | $98 - $498 | 44% |
| Western & Southern Financial Group | $98 | 44% |
| Cigna | $101 | 45% |
| Group Administrators | $101 | 45% |
| Health Partners | $101 | 45% |
| Mvp | $101 | 45% |
| Prairie States | $101 | 45% |
| Priority Health | $101 | 45% |
| Professional Benefit Administrators | $101 | 45% |
| Sagamore Health Network | $101 - $108 | 45% |
| Sisco Benefits | $101 | 45% |
| Unified Group Services | $101 | 45% |
| Goshen Preferred Network | $108 - $120 | 48% |
| Signature Care | $116 | 52% |
| Allied National Global Care | $126 | 56% |
| Asrm - Reliance Standard Life Insurance | $126 | 56% |
| Avmed Health Plan | $126 | 56% |
| Christian Care Ministry | $126 | 56% |
| Dean Health | $126 | 56% |
| Fallon Health | $126 | 56% |
| Family Life Insurance Company | $126 | 56% |
| Freedom Life Insurance Company | $126 | 56% |
| Ghc Scw | $126 | 56% |
| International Benefit Administrators | $126 | 56% |
| Lifetime Benefit Solutions | $126 | 56% |
| Manhattan Life | $126 | 56% |
| Medi Share | $126 | 56% |
| Multiplan | $126 | 56% |
| Pai | $126 | 56% |
| Pan-American Life | $126 | 56% |
| Paramount Hmo | $126 | 56% |
| Phcs | $126 | 56% |
| Philadelphia American Life Insurance | $126 | 56% |
| Trinity Health Share | $126 | 56% |
| Bankers Life Casualty | $140 | 63% |
| Bureau Of Disability | $140 | 63% |
| Wc Align Network | $140 | 63% |
| Medicare (plans) | $232 - $236 | 104% |
| Meridian Complete | $232 | 104% |
| Pace-Trinity Health | $232 | 104% |
| County Coroner | $241 | 108% |
| Provider Partners Health Plan Of Indiana | $255 | 114% |
| Physicians Health Plan Northern Indiana Health Insurance | $348 - $700 | 156% |
| St Joseph County Hlth Dpt | $348 | 156% |
| Caresource | $359 | 160% |
| Siho Insurance Services | $371 | 166% |
| Custom Design Benefits | $498 | 223% |
| Blue Benefit Administrators Of Massachusetts | $818 | 366% |
| Blue Care Network | $818 | 366% |
| Blue Distinction Transplant | $818 | 366% |
| Blue Shield - Ca | $818 | 366% |
| Blue Shield - Id (Regence) | $818 | 366% |
| Blue Shield - Ny Highmark Northeastern | $818 | 366% |
| Blue Shield - Ny Highmark Western | $818 | 366% |
| Blue Shield - Pa (Highmark) | $818 | 366% |
| Blue Shield - Wa (Regence) | $818 | 366% |