CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lafollette Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $216
  • Cash Discount Price: $322
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lafollette Medical Center is $216. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $322. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.97x the Medicare baseline. Located in 923 East Central Avenue, La Follette, TN.
Cash / Self-Pay
$322

Average discount available for prompt cash payment at this facility.

Insurance Median
$216

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: $322 (144%)
Insurance Median: $216 (97%)
Cash: $322 (144% of Medicare)
Ins. Median: $216 (97% 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.

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
Veterans Eval Services $7 3%
Blue Cross Blue Shield $13 - $209 6%
Bluecare $14 - $15 6%
Medicaid / KanCare $65 - $268 29%
UnitedHealthcare $65 - $1,074 29%
Amerigroup $145 65%
Tricare $194 87%
Node Champva $204 91%
Humana $209 - $236 93%
Medicare (plans) $209 93%
Node Bluecare Plus Tn Mcr Adv $209 93%
Triwest $209 93%
Node Hospice Non Par Agree $213 95%
Node Va $213 95%
Node Wellcare Mcr Adv $213 95%
Node Devoted Health Mcr Adv $214 96%
Node Farm Bureau Mcr Adv $214 96%
Aetna $216 - $668 97%
Node Blueadvantage Mcr Adv $216 97%
Node Healthspring Mcr Adv $216 97%
Node Amerigroup Mcr Adv $220 98%
Windsor Health Plan $220 98%
Node Nhc Mcr Adv $230 103%
Node Us Dept Of Labor $266 119%
Wellcare $268 120%
Novanet Work Comp Tn $302 135%
Tn Work Comp $305 136%
Self Pay $308 138%
Ambetter / Centene $394 176%
Node Point Comfort Underwriters $468 209%
Cigna $714 319%
Multiplan Complementary $816 365%
Beech Street Work Comp Tn $33,222 14850%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 923 East Central Avenue, La Follette, TN 37766
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals