CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Piedmont Mountainside Hospital Inc

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $275
Cash Discount Price: $116
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Piedmont Mountainside Hospital Inc is $275. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.23x the Medicare baseline. Located in 1266 Highway 515 South, Jasper, GA.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$275

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: $116 (52%)

Insurance Median: $275 (123%)

Cash: $116 (52% of Medicare)

Ins. Median: $275 (123% 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	$42 - $44	19%
UnitedHealthcare	$161 - $247	72%
First Health [10303]	$271	121%
Aetna	$275	123%
Novanet [10819]	$290	130%
Beechstreet [10800]	$310	139%
Phcs [10601]	$310	139%
Kaiser [10500]	$329	147%
Multiplan [10600]	$329	147%
Alliant Health Plans Of Georgia [10952]	$387	173%

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 $116.
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 Piedmont Mountainside Hospital Inc 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.