CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Fairfield Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $211
Cash Discount Price: $101
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Fairfield Medical Center is $211. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.94x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$211

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: $101 (45%)

Insurance Median: $211 (94%)

Cash: $101 (45% of Medicare)

Ins. Median: $211 (94% 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
Medicaid / KanCare	$60	27%
Molina	$60 - $10,067	27%
UnitedHealthcare	$60 - $6,101	27%
Caresource	$61 - $7,932	27%
Blue Cross Blue Shield	$62 - $26,250	28%
Amerihealth Caritas Ohio	$63	28%
Buckeye Community Health	$63 - $9,457	28%
Humana	$63 - $5,980	28%
Medical Mutual	$101 - $33,500	45%
Aetna	$148 - $5,980	66%
Allied Benefit Systems	$156	70%
Meritain Health	$156	70%
The Health Plan	$156 - $6,100	70%
Quality Care Partners/Ohio Ppo Connect	$162	72%
The Ohio State Health Plan	$173	77%
Cigna	$185	83%
Medicare (plans)	$208 - $5,980	93%
Medigold	$211 - $6,101	94%
Va Ccn	$211 - $6,101	94%
Ohio Healthy	$212	95%
Valor Health Plan	$212 - $6,100	95%
Multiplan	$214	96%
Miscellaneous Plans	$225	101%
Bwc	$293 - $8,475	131%
Oscar	$391 - $6,281	175%

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 $101.
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 Fairfield Medical Center 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.