CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Johnson County Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $105
Cash Discount Price: $78
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Johnson County Community Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.47x the Medicare baseline. Located in 1901 S Shady St, Mountain City, TN.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $78 (35%)

Insurance Median: $105 (47%)

Cash: $78 (35% of Medicare)

Ins. Median: $105 (47% 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 - $316	7%
UnitedHealthcare	$27 - $363	12%
Cigna	$49 - $195	22%
Aetna	$75 - $268	34%
Amerigroup	$75 - $122	34%
Managed Medicaire	$75 - $122	34%
Medicare (plans)	$75 - $122	34%
Sentara Health	$75 - $143	34%
United Mine Workers Of America	$75 - $122	34%
Wellcare	$75 - $122	34%
Humana	$76 - $124	34%
Molina Healthcare	$78 - $127	35%
Devoted Health Plan	$79 - $128	35%
Nhc Advantage	$79 - $128	35%
Optima Health	$80	36%
Ambetter / Centene	$83 - $134	37%
Medcost	$90 - $147	40%
First Health Coventry	$194 - $315	87%
Seven Corners, Inc.	$258 - $420	115%

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 $78.
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 Johnson County Community 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.