CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Pulaski Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $90
Cash Discount Price: $92
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Pulaski Memorial Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.40x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $92 (41%)

Insurance Median: $90 (40%)

Cash: $92 (41% of Medicare)

Ins. Median: $90 (40% 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
Ambetter / Centene	$37 - $45	17%
Blue Cross Blue Shield	$37 - $144	17%
Caresource Mcaid Hip	$37 - $45	17%
Caresource Mcare Hmo	$37 - $45	17%
Cenpatico Mcaid Hip	$37 - $45	17%
Humana	$37 - $116	17%
Mdwise Mcaid Hip - All Other Plans	$37 - $45	17%
Mhs Mcaid Hip	$37 - $45	17%
Mhs Mcare Allwell	$37 - $45	17%
UnitedHealthcare	$37 - $144	17%
Aetna	$43 - $52	19%
Caresource Exch Hmo Hix - All Other Plans	$46 - $56	21%
Sagamore Rose Acre	$88 - $108	39%
Sagamore - All Other Plans	$89 - $109	40%
Encore Ppo - All Other Plans	$100 - $123	45%
Community Health Alliance - All Plans	$105 - $129	47%
Encore Workers Comp	$106 - $130	47%
Multiplan - All Plans	$106 - $130	47%
Cigna	$112 - $137	50%
Caresource Mcaid Hhw	$118 - $144	53%
Cenpatico Mcaid Hhw - All Other Plans	$118 - $144	53%
Mdwise Mcaid Hcc	$118 - $144	53%
Mdwise Mcaid Hhw	$118 - $144	53%
Mhs Mcaid Hhw/Hcc	$118 - $144	53%

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 $92.
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 Pulaski Memorial 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.