CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: T J Samson Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $223
Cash Discount Price: $131
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at T J Samson Community Hospital is $223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.00x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$223

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: $131 (59%)

Insurance Median: $223 (100%)

Cash: $131 (59% of Medicare)

Ins. Median: $223 (100% 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	$11	5%
Humana	$11 - $223	5%
Molina Mcaid	$12	5%
UnitedHealthcare	$35 - $278	16%
Blue Cross Blue Shield	$38 - $304	17%
Center Care Select - All Plans	$38 - $304	17%
Phcs/Multiplan - All Plans	$42 - $337	19%
First Health - All Plans	$43 - $340	19%
Wellcare Mcaid	$218	97%
Wellcare Mcr Adv - All Other Plans	$223	100%
Signature Health - All Plans	$225	101%
Molina Mcr Adv	$227	101%
Devoted Mcr Adv - All Plans	$234	105%
Caresource - All Plans	$334	149%
Molina Marketplace - All Other Plans	$334	149%

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 $131.
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 T J Samson 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.