CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Blount Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $279
Cash Discount Price: $208
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Blount Memorial Hospital is $279. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $208. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.25x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$208

Average discount available for prompt cash payment at this facility.

Insurance Median

$279

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: $208 (93%)

Insurance Median: $279 (125%)

Cash: $208 (93% of Medicare)

Ins. Median: $279 (125% 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
UnitedHealthcare	$12 - $346	5%
Medicaid / KanCare	$17 - $181	8%
Blue Cross Blue Shield	$69 - $214	31%
Prisma Health Seniorcare Pace - Midlands [5400]	$155	69%
Prisma Health Seniorcare Pace-Upstate [5200]	$155	69%
Tricare	$189	84%
Humana	$206	92%
Medicare (plans)	$206 - $214	92%
Cigna	$214 - $368	96%
Promise Health Plan Contracted [2401]	$234 - $402	105%
Orangeburg Senior Helping Center Pace [5401]	$268	120%
Mvp Health Care [3037]	$279	125%
Ambetter / Centene	$322	144%
Golden Rule Insurance Company [2991]	$346	155%
Oxford Health Plans [2992]	$346	155%
Bob Jones Univ-Pai [821]	$402	180%
Consociate Health Contracted [4835]	$457	204%
Preferred Administrators Contracted [2839]	$469	210%
Fairos/Occunet Contracted [4837]	$478	214%
Medcost [2940]	$496 - $556	222%
Atlantic Packaging Contracted [4833]	$502	224%
Aps Healthcare System [2981]	$536	240%
Multiplan/Phcs Contracted [2950]	$596	266%
Aetna	$603	270%
Meritain Health Contracted [2200]	$603	270%
Nippon [2300]	$603	270%
Vsp Vision Care [2986]	$603	270%
First Health Contracted [2952]	$623	278%
Furman Int/Allen University Student [2951]	$623	278%
Quiktrip-First Health [3067]	$623	278%

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 $208.
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 Blount 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.