CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Margaretville Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $202
  • Cash Discount Price: $459
  • vs. Medicare Baseline: 0.90x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Margaretville Memorial Hospital is $202. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $459. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.90x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.
Cash / Self-Pay
$459

Average discount available for prompt cash payment at this facility.

Insurance Median
$202

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: $459 (205%)
Insurance Median: $202 (90%)
Cash: $459 (205% of Medicare)
Ins. Median: $202 (90% 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.

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
Mvp $33 15%
Mvp Hmo/Ppo $39 17%
Blue Cross Blue Shield $89 - $317 40%
Self-Pay $123 55%
UnitedHealthcare $130 - $202 58%
Oxford $139 - $153 62%
Oxford Exchange $148 66%
Medicare (plans) $202 - $303 90%
Aetna $202 - $298 90%
Mvp Gold (McR) $202 90%
Hamaspik (McR) $202 90%
Affinity By Molina McR $212 95%
Cdphp $222 99%
Mvp Exchange $298 133%
Emblem Select Care (Exchange) $312 139%
Magnacare Standard $321 143%
Emblem Ghi/Hip Ppo/Cbp $330 148%
Todays Options $333 149%
Emblem Ghi/Hip Hmo/Epo/Pos $367 164%
Magnacare Preferred $367 164%
Multiplan $376 168%
First Health $413 185%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 42084 State Highway 28, Margaretville, NY 12455
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals