CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Franciscan Health Lafayette

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $104
Cash Discount Price: $35
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Franciscan Health Lafayette is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.46x the Medicare baseline. Located in 1701 S Creasy Ln, Lafayette, IN.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $35 (16%)

Insurance Median: $104 (46%)

Cash: $35 (16% of Medicare)

Ins. Median: $104 (46% 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
Mdwise [1175]	$25	11%
Medicaid / KanCare	$25 - $30	11%
Managed Health Services [1302]	$26	12%
Aetna	$64 - $111	29%
Managed Care [2000]	$64 - $141	29%
UnitedHealthcare	$68 - $84	30%
Commercial [2001]	$76 - $157	34%
United Medical Resources [1158]	$76	34%
United Medical Resources [1301]	$76 - $84	34%
Humana	$106	47%
Cigna	$108 - $126	48%
Great West Insurance [1055]	$108	48%
Medicare (plans)	$232	104%
Workers Comp [1172]	$463	207%
Blue Cross Blue Shield	$560 - $858	250%
Unicare [1150]	$858	384%

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 $35.
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 Franciscan Health Lafayette 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.