CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Catawba Valley Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $111
Cash Discount Price: $72
vs. Medicare Baseline: 0.50x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Catawba Valley Medical Center is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.50x the Medicare baseline. Located in 810 Fairgrove Church Rd, Hickory, NC.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $72 (32%)

Insurance Median: $111 (50%)

Cash: $72 (32% of Medicare)

Ins. Median: $111 (50% 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	$28 - $208	13%
Medcost	$29 - $126	13%
Cigna	$31 - $198	14%
Directnet	$34 - $110	15%
Aetna	$35 - $112	16%
Prime Health Service	$43 - $138	19%
Humana	$46 - $202	21%
Multiplan	$48 - $156	21%
UnitedHealthcare	$104 - $198	46%
Wellcare	$204	91%
Devoted Health	$208	93%
Gateway	$208	93%
Longevity Healthcare	$208	93%
Liberty Advantage	$210	94%
Troy	$210	94%
Caresource North Carolina	$445	199%

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 $72.
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 Catawba Valley 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.