CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Novant Health Forsyth Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $227
Cash Discount Price: $241
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Novant Health Forsyth Medical Center is $227. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $241. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.01x the Medicare baseline. Located in 3333 Silas Creek Parkway, Winston-Salem, NC.

Cash / Self-Pay

$241

Average discount available for prompt cash payment at this facility.

Insurance Median

$227

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: $241 (108%)

Insurance Median: $227 (101%)

Cash: $241 (108% of Medicare)

Ins. Median: $227 (101% 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
Blue Cross Blue Shield	$12 - $280	5%
Carolina Complete	$73 - $76	33%
Nc Department Of Public Safety	$73 - $425	33%
Amerihealth	$75 - $77	34%
UnitedHealthcare	$75 - $274	34%
Wellcare	$75 - $77	34%
Cigna	$153 - $242	68%
Caresource North Carolina	$158 - $163	71%
Humana	$212 - $317	95%
Pace Of The Southern Piedmont	$212	95%
Aetna	$218 - $326	97%
Atlantic Corporation Dba Atlantic Packaging	$223 - $230	100%
Liberty Health	$223	100%
Plotkin Health	$237 - $244	106%
Amps	$257 - $265	115%
Medcost	$336 - $383	150%
Primary Physician Care	$348 - $358	156%
Beechstreet	$356 - $366	159%
Multiplan	$356 - $366	159%
Phcs	$356 - $366	159%
Employers Choice Network	$383 - $395	171%
Three Rivers Provider Network	$383 - $395	171%

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 $241.
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 Novant Health Forsyth Medical Center 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.