CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Fostoria Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $116
Cash Discount Price: $142
vs. Medicare Baseline: 0.52x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Fostoria Community Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.52x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $142 (63%)

Insurance Median: $116 (52%)

Cash: $142 (63% of Medicare)

Ins. Median: $116 (52% 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
Blue Cross Blue Shield	$8 - $887	4%
Buckeye Community Health Plan	$8 - $97	4%
Health Alliance Plan	$8 - $164	4%
Health Value Management	$8 - $47	4%
Paramount Health Care	$8 - $116	4%
Aetna	$9 - $147	4%
Buckeye Community Health Plan Inc	$9 - $80	4%
Dayton Area Health Plan Dba Caresource	$10 - $95	4%
UnitedHealthcare	$10 - $131	4%
Veterans Affairs	$48	21%
Amerihealth	$100	45%
Meridian Health Plan Of Mi	$120	54%
Medical Mutual Of Ohio	$124 - $132	55%
Frontpath Health Coalition	$126	56%
Ohio Health Choice	$142	63%
Ohio Ppo Connect	$142 - $164	63%
Health Ohio Network	$173	77%
Connecticut General Life Insurance Company	$175	78%

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 $142.
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 Fostoria Community 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.