CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Wayne General Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $100
Cash Discount Price: $94
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Wayne General Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.45x the Medicare baseline. Located in 950 Matthew Dr, Waynesboro, MS.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $94 (42%)

Insurance Median: $100 (45%)

Cash: $94 (42% of Medicare)

Ins. Median: $100 (45% 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
Cigna	$23 - $207	10%
Ml Healthcare-All Plans	$31 - $78	14%
Phcs-All Plans	$58 - $146	26%
Mhci/Healthlink Op Only-All Plans	$66 - $166	30%
Ms Health Partners-All Plans	$66 - $166	30%
Ppoplus-All Plans	$66 - $166	30%
First Choice-All Other Plans	$70 - $176	31%
First Health-All Plans	$70 - $176	31%
Geha Ppo-All Plans	$70 - $176	31%
Healthcare Advantage-All Plans	$70 - $176	31%
United Providers-All Plans	$70 - $176	31%
Three Rivers Provider Network-All Plans	$74 - $185	33%
Aetna	$78 - $207	35%
Magnolia Comm/Exchange-All Other Plans	$78 - $207	35%
First Choice Hie	$98 - $259	44%
Blue Cross Blue Shield	$146 - $365	65%
Al Healthcare Adv Mcaid-All Plans	$147	66%
Alabama Community Mcaid-All Plans	$147	66%
Medicaid / KanCare	$147	66%
Univita Healthcare Mcaid-All Plans	$147	66%
Molina Chip-All Other Plans	$162	72%
Humana	$182 - $187	81%
Amerigroup Mcare Adv-All Plans	$202 - $207	90%
Magnolia Mcare Adv	$202 - $207	90%
Molina Mcare Adv	$202 - $207	90%
Vantage Health Mcare Adv	$202 - $207	90%
Wellcare Mcare Adv-All Plans	$202 - $207	90%
Ahs-All Plans	$350	156%
Vantage Health-All Other Plans	$465 - $477	208%

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 $94.
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 Wayne General 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.