CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Tristar Northcrest Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $291
Cash Discount Price: $1,213
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Tristar Northcrest Medical Center is $291. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,213. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.30x the Medicare baseline. Located in 100 Northcrest Drive, Springfield, TN.

Cash / Self-Pay

$1,213

Average discount available for prompt cash payment at this facility.

Insurance Median

$291

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: $1,213 (542%)

Insurance Median: $291 (130%)

Cash: $1,213 (542% of Medicare)

Ins. Median: $291 (130% 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
Blue Cross Blue Shield	$15	7%
Molina	$85	38%
Bright Health	$182 - $255	81%
Oscar	$190	85%
Nhc Advantage, Inc.	$231	103%
Ambetter / Centene	$234 - $243	105%
United	$268 - $546	120%
Aetna	$291 - $607	130%
Cigna	$306 - $356	137%
City Of Springfield	$789	353%
Multiplan	$946 - $995	423%

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 $1,213.
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 Tristar Northcrest Medical Center 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.