CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Monroe Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $108
Cash Discount Price: $230
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Monroe Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $230. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.48x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$230

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $230 (103%)

Insurance Median: $108 (48%)

Cash: $230 (103% of Medicare)

Ins. Median: $108 (48% 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	$25 - $415	11%
Care Source	$25 - $334	11%
Medicaid / KanCare	$25	11%
Monroe Medical Group And Managed Health Services	$25 - $311	11%
UnitedHealthcare	$25 - $231	11%
Aetna	$53 - $231	24%
Americas Choice Provider Network Acpn	$53 - $447	24%
Corvel Workers Compensation	$53 - $401	24%
Employer Direct Healthcare	$53 - $323	24%
Encore Health Network Workers Compensation	$53 - $452	24%
Medicare (plans)	$53 - $231	24%
Multiplan	$53 - $447	24%
Prime Health Services	$53 - $447	24%
Provider Network Of America	$53 - $461	24%
Provider Partners Health Plan	$53 - $254	24%
Provider Select	$53 - $456	24%
Three Rivers	$53 - $447	24%
Tricare	$53 - $231	24%
Usa Senior Care Network	$53 - $231	24%
Workers Compensation	$53 - $461	24%
Worthington Christian Fellowship	$53 - $231	24%
Zelis Healthcare Fka Stratose	$53 - $438	24%

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 $230.
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 Monroe 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.