CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Atrium Health Cleveland

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $70
Cash Discount Price: $80
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Atrium Health Cleveland is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.31x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $80 (36%)

Insurance Median: $70 (31%)

Cash: $80 (36% of Medicare)

Ins. Median: $70 (31% 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	$7 - $198	3%
Cigna	$7 - $201	3%
Humana	$7 - $195	3%
UnitedHealthcare	$7 - $201	3%
Alliance	$10 - $27	4%
Amerihealth Caritas	$10 - $23	4%
Carolina Complete Health	$10 - $23	4%
Healthy Blue	$10 - $23	4%
Partners	$10 - $23	4%
Trillium	$10 - $24	4%
Vaya	$10 - $23	4%
Wellcare	$10 - $23	4%
Blue Cross Blue Shield	$32 - $66	14%
Choicecare	$33 - $132	15%
Medcost	$44 - $107	20%
Ambetter / Centene	$51 - $58	23%
Employers Health Network	$71	32%
Physician Reach Out	$80	36%
Magellan	$97	43%
Gmmi	$105	47%
Quik Trip	$105	47%
Carolina Behavioral Health	$116 - $129	52%
Healthgram	$129	58%
First Health	$137	61%
Lifesynch Community Choice Care	$137	61%
Private Health Care Systems	$145	65%
Beechstreet	$148	66%
Multiplan	$153	68%

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 $80.
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 Atrium Health Cleveland 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.