CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ohiohealth Morrow County Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $77
Cash Discount Price: $59
vs. Medicare Baseline: 0.34x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ohiohealth Morrow County Hospital is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.34x the Medicare baseline. Located in 651 West Marion Road, Mount Gilead, OH.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $59 (26%)

Insurance Median: $77 (34%)

Cash: $59 (26% of Medicare)

Ins. Median: $77 (34% 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
Aetna	$34 - $78	15%
Blue Cross Blue Shield	$34 - $81	15%
Humana	$34 - $84	15%
Medicare (plans)	$34	15%
UnitedHealthcare	$34 - $80	15%
Caresource Marketplace - All Other Plans	$42	19%
Medical Mutual Of Ohio Marketplace	$68	30%
Ohiohealthy Network - All Other Plans	$68	30%
Ohiohealthy Preferred	$68	30%
Medical Mutual Of Ohio Comm - All Other Plans	$74	33%
Medical Mutual Of Ohio - Admin Serv	$77	34%
Medicaid / KanCare	$80 - $81	36%
Amerihealth Caritas - All Plans	$82	37%
Phcs - All Plans	$84	38%
Cigna	$85	38%
Multiplan - All Plans	$86	38%
Healthstar Comm - All Plans	$87	39%
Beech Street - All Plans	$88	39%
Molina Exchange - All Other Plans	$132	59%

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 $59.
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 Ohiohealth Morrow County 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.