CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Highlands Cashiers Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $106
Cash Discount Price: $359
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Highlands Cashiers Hospital is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $359. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.47x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$359

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $359 (160%)

Insurance Median: $106 (47%)

Cash: $359 (160% of Medicare)

Ins. Median: $106 (47% 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
Apex Health	$19 - $124	8%
Cigna	$32 - $275	14%
Blue Cross Blue Shield	$33 - $258	15%
United	$33 - $376	15%
Amerihealth	$34 - $220	15%
Wellcare	$34 - $217	15%
Partners Health Management	$35 - $222	16%
Vaya Health	$35 - $222	16%
Amerihealth Caritas	$37 - $236	17%
Aetna	$38 - $451	17%
Caresource	$43 - $273	19%
Oscar	$44 - $284	20%
Medcost	$45 - $350	20%
Magellan	$58 - $372	26%
Magellan Behavioral Health	$58 - $372	26%
Multiplan	$77 - $496	34%
Avalon Administrative Services	$82 - $527	37%
Prime Health	$85 - $558	38%

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 $359.
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 Highlands Cashiers 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.