CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Graham Regional Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $130
Cash Discount Price: $195
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Graham Regional Medical Center is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $195. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.58x the Medicare baseline. Located in 1301 Montgomery Road, Graham, TX.

Cash / Self-Pay

$195

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $195 (87%)

Insurance Median: $130 (58%)

Cash: $195 (87% of Medicare)

Ins. Median: $130 (58% 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
Amerigroup	$13 - $172	6%
Choicecare Network	$13 - $172	6%
Superior Healthplan	$13 - $172	6%
Wellpoint	$18 - $232	8%
Curative	$26 - $343	12%
Aetna	$29 - $372	13%
Cigna	$29 - $372	13%
Blue Cross Blue Shield	$30 - $429	13%
Three Rivers Provider Network	$37 - $486	17%
Health Advantage Network	$40 - $515	18%
Healthsmart Preferred Care	$40 - $515	18%
UnitedHealthcare	$260	116%

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 $195.
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 Graham Regional 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.