CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Caromont Regional Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $143
Cash Discount Price: $288
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Caromont Regional Medical Center is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $288. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.64x the Medicare baseline. Located in 2525 Court Dr, Gastonia, NC.

Cash / Self-Pay

$288

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $288 (129%)

Insurance Median: $143 (64%)

Cash: $288 (129% of Medicare)

Ins. Median: $143 (64% 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	$24 - $361	11%
Carolina Complete Health	$24 - $118	11%
Partners Behavioral Health	$24 - $118	11%
Alliance Behavioral Health	$25 - $120	11%
Amerihealth Caritas	$25 - $120	11%
Carolina Complete Health Tailored Plans	$25 - $120	11%
UnitedHealthcare	$25 - $417	11%
Vaya Behavioral Health	$25 - $120	11%
Wellcare	$25 - $120	11%
Absolute Total Care	$45 - $220	20%
Molina	$45 - $235	20%
Gaston County Jail	$48 - $236	21%
Aetna	$80 - $388	36%
Medcost	$109 - $533	49%
Cigna	$116 - $565	52%
Carolina Caring	$128 - $621	57%
Beech Street	$132 - $643	59%
Multiplan	$132 - $643	59%
Humana	$142 - $690	63%
Self Pay	$145 - $588	65%
First Health Network	$153 - $745	68%
Devoted Health	$235	105%
Healthteam	$235	105%
Longevity Health	$235	105%
Surgery Plus	$392	175%
Corporate Benefits Service	$602	269%

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 $288.
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 Caromont Regional 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.