CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Claire Regional Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $65
  • Cash Discount Price: $177
  • vs. Medicare Baseline: 0.29x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Claire Regional Medical Center is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.29x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.
Cash / Self-Pay
$177

Average discount available for prompt cash payment at this facility.

Insurance Median
$65

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: $177 (79%)
Insurance Median: $65 (29%)
Cash: $177 (79% of Medicare)
Ins. Median: $65 (29% 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.

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
Medicaid / KanCare $5 - $224 2%
Wellcare Mcaid $5 - $228 2%
Blue Cross Blue Shield $8 - $227 4%
Caresource Mcr Adv $8 - $227 4%
Healthlink - All Plans $8 - $188 4%
Humana $8 - $227 4%
Ky Health Co-Op - All Plans $10 - $352 4%
Wellcare Comm - All Other Plans $10 - $230 4%
Aetna $11 - $224 5%
Caresource Just4Me - All Other Plans $11 - $295 5%
Beacon Bh - All Plans $12 5%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 222 Medical Circle, Morehead, KY 40351
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Federal
  • Hospital Type: Acute Care Hospitals