CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Pender Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $147
Cash Discount Price: $199
vs. Medicare Baseline: 0.66x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Pender Memorial Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $199. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.66x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$199

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $199 (89%)

Insurance Median: $147 (66%)

Cash: $199 (89% of Medicare)

Ins. Median: $147 (66% 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 - $168	5%
Humana	$85 - $392	38%
Pace Of The Southern Piedmont	$90 - $123	40%
Aetna	$92 - $388	41%
New Hanover Health	$92 - $126	41%
Cigna	$93 - $201	42%
Carolina Complete	$94 - $128	42%
Nc Department Of Public Safety	$94 - $246	42%
Amerihealth	$95 - $131	42%
Wellcare	$95 - $131	42%
Ambetter / Centene	$126 - $172	56%
Liberty Health	$128 - $175	57%
Caresource North Carolina	$133 - $182	59%
Plotkin Health	$200 - $274	89%
UnitedHealthcare	$243 - $333	109%
Medcost	$251 - $383	112%
Employers Choice Network	$323 - $442	144%
Three Rivers Provider Network	$323 - $442	144%

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 $199.
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 Pender Memorial 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.