CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ochsner St Mary

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $79
Cash Discount Price: $46
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ochsner St Mary is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.35x the Medicare baseline. Located in 1125 Marguerite Street, Morgan City, LA.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

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: $46 (21%)

Insurance Median: $79 (35%)

Cash: $46 (21% of Medicare)

Ins. Median: $79 (35% 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
Healthy Blue (Healthy Louisiana)	$15 - $36	7%
Humana	$15 - $185	7%
Louisiana Healthcare Connections (Healthy Louisiana)	$15 - $36	7%
UnitedHealthcare	$15 - $185	7%
Aetna	$16 - $242	7%
Amerihealth Caritas Louisiana (Healthy Louisiana)	$16 - $37	7%
Verity Commercial And First Choice Network	$64 - $153	29%
Blue Cross Blue Shield	$65 - $185	29%
Claritev D/B/A Multiplan/Phcs/American Life Care	$69 - $165	31%
Tricare	$78 - $198	35%
First Health Network	$80 - $190	36%
Healthcomp & Personify Health (Formerly Gilsbar)	$83 - $199	37%
American Health Advantage Of Louisiana (Formerly Dignity Health Plan)	$185	83%
Healthy Blue Dual Advantage (Hmo-D-Snp)	$185	83%
Medicare (plans)	$185	83%
Ochsner Health Plan	$185	83%
Zelis	$279	125%
Cigna	$291	130%

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 $46.
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 Ochsner St Mary 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.