CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: John Randolph Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $165
Cash Discount Price: $370
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at John Randolph Medical Center is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $370. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.74x the Medicare baseline. Located in 411 West Randolph Road, Hopewell, VA.

Cash / Self-Pay

$370

Average discount available for prompt cash payment at this facility.

Insurance Median

$165

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: $370 (165%)

Insurance Median: $165 (74%)

Cash: $370 (165% of Medicare)

Ins. Median: $165 (74% 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
Oscar	$48 - $78	21%
Lifeworks	$53 - $87	24%
United	$58 - $207	26%
Universal Healthcare Group	$62 - $101	28%
Aetna	$90 - $151	40%
Virginia Health Network	$98 - $298	44%
Value Options	$169 - $275	76%
Corvel	$202 - $330	90%
Occunet Workers Comp	$225 - $367	101%
4Most Health Nework	$253 - $413	113%
Multiplan	$253 - $413	113%

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 $370.
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 John Randolph 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.