CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Cannon Memorial Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $71
- Cash Discount Price: $88
- vs. Medicare Baseline: 0.32x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cannon Memorial Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.32x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.
Cash / Self-Pay
$88
Average discount available for prompt cash payment at this facility.
Insurance Median
$71
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: $88 (39%)
Insurance Median: $71 (32%)
Cash: $88 (39% of Medicare)
Ins. Median: $71 (32% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Absolute Total Care [58] | $5 - $200 | 2% |
| Humana | $5 - $200 | 2% |
| Medicaid / KanCare | $5 - $275 | 2% |
| Select Health Of Sc [637] | $5 - $182 | 2% |
| Absolute Total Care Mcr Plans Alt Payer [4101] | $7 | 3% |
| Absolute Total Care Mcr Plans [41] | $7 | 3% |
| Aetna | $7 - $156 | 3% |
| Blue Choice Health Plan [922] | $7 - $68 | 3% |
| Blue Cross Blue Shield | $7 - $261 | 3% |
| Champva [604] | $7 | 3% |
| Cigna | $7 - $275 | 3% |
| Devoted Health Alt Payer [9401] | $7 | 3% |
| Devoted Health [94] | $7 | 3% |
| First Choice Vip Careplus Alt Payer [3301] | $7 | 3% |
| First Choice Vip [33] | $7 | 3% |
| Medicare (plans) | $7 - $275 | 3% |
| Molina Dual Options Alt Payer [1501] | $7 | 3% |
| Molina Dual Options [15] | $7 | 3% |
| Nhc Advantage Alt Payer [6101] | $7 | 3% |
| Nhc Advantage [61] | $7 | 3% |
| Tricare | $7 | 3% |
| UnitedHealthcare | $7 - $275 | 3% |
| Vaccn - Va Community Care Network [16] | $7 | 3% |
| Veterans Administration [633] | $7 | 3% |
| Ambetter / Centene | $10 | 4% |
| First Choice Next [96] | $10 | 4% |
| Molina Marketplace [97] | $10 | 4% |
| Mail Handlers Benefit Plan [327] | $11 - $156 | 5% |
| Rural Carrier Benefit Plan [406] | $11 - $156 | 5% |
| Edison Health Solutions [95] | $12 | 5% |
| Healthscope [98] | $12 | 5% |
| Bright Health Alt Payer [1001] | $14 | 6% |
| Workers Compensation [622] | $15 | 7% |
| Planned Administrators [886] | $19 - $63 | 8% |
| Thomas Cooper & Company [315] | $19 - $63 | 8% |
| Employee Benefit Management Services [869] | $20 - $77 | 9% |
| Bright Health [11] | $22 | 10% |
| Geha [302] | $24 - $147 | 11% |
| Golden Rule Ins Co [584] | $24 - $147 | 11% |
| Preferred Administrators [19] | $25 - $165 | 11% |
| Nalc Health Benefit Plan [291] | $27 - $164 | 12% |
| Medcost [206] | $29 - $248 | 13% |
| Phcs [940] | $36 - $182 | 16% |
| Coventry Health [245] | $109 - $198 | 49% |
| Other Hospital Payers [1991] | $131 - $275 | 59% |
| American Continental Ins [778] | $175 - $275 | 78% |
| American Republic Life Ins [722] | $175 - $275 | 78% |
| Business Office [6000] | $175 - $275 | 78% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [17] | $175 - $275 | 78% |
| First Health [946] | $175 - $275 | 78% |
| Guarantee Trust Life Insurance [236] | $175 - $275 | 78% |
| Home Health Infusion Payer [6001] | $175 - $275 | 78% |
| Manhattan Life Ins Co [932] | $175 - $275 | 78% |
| Miscellaneous Commercial [1] | $175 - $275 | 78% |
| New Era Life Ins Co [437] | $175 - $275 | 78% |
| Non-Contracted [22] | $175 - $275 | 78% |
| Physicians Mutual [773] | $175 - $275 | 78% |
| Reference Based Pricing/Limited Plan [21] | $175 - $275 | 78% |
| State Farm Ins Co [373] | $175 - $275 | 78% |
| Sterling Investors Life [244] | $175 - $275 | 78% |
| Supermed/Med Mutual Of Ohio [539] | $175 - $275 | 78% |
| United American Ins Co [277] | $175 - $275 | 78% |