CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $404
  • Cash Discount Price: $252
  • vs. Medicare Baseline: 1.81x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Carilion Stonewall Jackson Hospital is $404. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $252. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.81x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$252

Average discount available for prompt cash payment at this facility.

Insurance Median
$404

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: $252 (113%)
Insurance Median: $404 (181%)
Cash: $252 (113% of Medicare)
Ins. Median: $404 (181% 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.

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 $7 - $1,022 3%
Sentara Health Plan $7 - $447 3%
Abh of VA (Formerly Coventry) $8 4%
Abh of Wva (Formerly Coventry) $8 4%
Humana $8 - $209 4%
UnitedHealthcare $8 - $589 4%
Aetna $192 - $479 86%
Gateway - Tier 3 $397 177%
Vhn - Ultra $447 200%
Connecticare $505 226%
Gateway - Tier 2 $577 258%
Vhn - Plus $577 258%
Cigna $578 258%
Integrated Health Plan $613 274%
Vhn $613 274%
Vhn - Link $649 290%
Beech Street $663 296%
Gateway - Tier 1 $685 306%
Vhn - Secondary Payors $685 306%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals