CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: PAM Specialty Hospital of Rocky Mount LLC

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $149
Cash Discount Price: $191
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at PAM Specialty Hospital of Rocky Mount LLC is $149. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.67x the Medicare baseline. Located in 1051 Noell Ln, Rocky Mount, NC.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$149

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: $191 (85%)

Insurance Median: $149 (67%)

Cash: $191 (85% of Medicare)

Ins. Median: $149 (67% 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
America'S Choice	$103 - $204	46%
Provider Network Of America	$111 - $219	50%
Quik Trip	$111 - $219	50%
Usa Managed Care Organization	$111 - $219	50%
Velocity Provider Ppo Network	$111 - $219	50%
Healthsmart	$115 - $227	51%
Evolutions Healthcare System	$118 - $233	53%
Multiplan/Phcs	$118 - $233	53%
Fortified Provider Network	$126 - $248	56%
Prime Health Services	$126 - $248	56%
Integrated Health Plan	$140 - $277	63%

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 $191.
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 PAM Specialty Hospital of Rocky Mount LLC 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.