CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Uva Health Culpeper Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $273
Cash Discount Price: $7,112
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Uva Health Culpeper Medical Center is $273. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,112. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.22x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$7,112

Average discount available for prompt cash payment at this facility.

Insurance Median

$273

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: $7,112 (3179%)

Insurance Median: $273 (122%)

Cash: $7,112 (3179% of Medicare)

Ins. Median: $273 (122% 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
Veterans [99909]	$3	1%
Champva [50002]	$9	4%
Tricare	$9	4%
Carefirst [30007]	$28 - $5,036	13%
Sentara [40021]	$82 - $186	37%
Sentara Behavioral Health [40052]	$83 - $186	37%
Aetna	$114 - $5,603	51%
Cigna	$160 - $6,128	72%
Beacon Health Options [40012]	$166	74%
Commercial Contracted Hb Only [40056]	$174	78%
Commercial Generic [40000]	$174 - $232	78%
Multiplan Generic [40035]	$182 - $282	81%
Vhn Generic [40040]	$182 - $282	81%
Geha [40009]	$193 - $10,648	86%
UnitedHealthcare	$193 - $15,506	86%
Blue Ridge Pace [10510]	$198 - $3,366	89%
Medicaid / KanCare	$198 - $3,366	89%
Commercial Contracted Tpa [40055]	$199 - $232	89%
Kaiser Permenente [40014]	$216	97%
Blue Cross Blue Shield	$220 - $15,506	98%
HMO Part B [10099]	$220 - $3,741	98%
Humana	$220 - $5,658	98%
Medicare (plans)	$220 - $5,547	98%
VA Ccn [99926]	$220 - $5,547	98%
VA Ccn [99927]	$220 - $5,547	98%
Veterans Administration [99910]	$227 - $5,547	101%
Umwa [40037]	$232	104%
Healthsmart [40013]	$249	111%
First Health Generic [40033]	$272	122%
Gateway Health Alliance [40034]	$282	126%
Onenet Workers Comp Generic [60010]	$291	130%

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 $7,112.
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 Uva Health Culpeper 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.