CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $131
Cash Discount Price: $193
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Children's Healthcare of Atlanta at Scottish Rite is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.59x the Medicare baseline. Located in 1001 Johnson Ferry Road, Atlanta, GA.

Cash / Self-Pay

$193

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $193 (86%)

Insurance Median: $131 (59%)

Cash: $193 (86% of Medicare)

Ins. Median: $131 (59% 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
Peachstate [43]	$37 - $242	17%
Amerigroup [102]	$38 - $252	17%
Caresource [61]	$38 - $249	17%
Blue Cross Blue Shield	$58 - $566	26%
Cigna	$58 - $383	26%
United [5]	$58 - $385	26%
Aetna	$59 - $390	26%
Ambetter / Centene	$59 - $388	26%
Oscar [228]	$59 - $389	26%
Caresource Marketplace Bronze/Silver/Gold [60]	$60 - $394	27%
Kaiser [6]	$60 - $395	27%
Sidecar Health [236]	$61 - $400	27%
Coventry [9]	$62 - $407	28%
Direct Employer Agreements [72]	$62 - $493	28%
First Health [74]	$66 - $435	30%
Northeast Georgia Heatlh System [808]	$66 - $435	30%
Veracity Benefits [809]	$66 - $435	30%
Phcs [93]	$75 - $493	34%
Secure Health [340]	$75 - $493	34%
Beech Street [71]	$79 - $522	35%
Multiplan [92]	$86 - $568	38%
Novanet [41]	$88 - $580	39%

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 $193.
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 Children's Healthcare of Atlanta at Scottish Rite 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.