CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adena Pike Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $204
Cash Discount Price: $232
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adena Pike Medical Center is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $232. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.91x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$232

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $232 (104%)

Insurance Median: $204 (91%)

Cash: $232 (104% of Medicare)

Ins. Median: $204 (91% 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	$52 - $579	23%
Blue Cross Blue Shield	$52 - $614	23%
Buckeye Community Health Plan	$52 - $171	23%
Humana	$52 - $676	23%
Medical Mutual Of Ohio	$52 - $452	23%
Medigold	$52 - $171	23%
Molina	$52 - $171	23%
Care Source	$53 - $174	24%
Gateway Health	$71 - $235	32%
Molina Marketplace	$85 - $280	38%
Care Source Just4Me	$93 - $308	42%
Sidecar Health	$142 - $470	63%
Ohio Ppo Connect	$151 - $498	67%
The Health Plan	$151 - $498	67%
Cigna	$156 - $515	70%
Medical Mutual Of Ohio Supermed	$163 - $536	73%
First Health	$169 - $558	76%
Ohio Health Choice	$172 - $567	77%
UnitedHealthcare	$186 - $612	83%
Integrated Health Plan	$203 - $669	91%
Healthsmart	$205 - $676	92%
Multiplan/Private Healthcare Systems	$205 - $676	92%
Three Rivers Network	$205 - $676	92%

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 $232.
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 Adena Pike 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.