CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lee County Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $106
Cash Discount Price: $78
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lee County Community Hospital is $106. 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 127 Health Care Drive, Pennington Gap, VA.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$106

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: $106 (47%)

Cash: $78 (35% of Medicare)

Ins. Median: $106 (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	$16 - $420	7%
UnitedHealthcare	$27 - $363	12%
Aetna	$57 - $420	25%
Ambetter / Centene	$57 - $92	25%
Amerigroup	$57 - $420	25%
Managed Medicaire	$57 - $92	25%
Medicare (plans)	$57 - $92	25%
Mountain Empire Pace	$57 - $92	25%
Sentara Health	$57 - $108	25%
United Mine Workers Of America	$57 - $92	25%
Humana	$58 - $94	26%
Molina Healthcare	$59 - $110	26%
Cigna	$60 - $420	27%
Devoted Health Plan	$60 - $97	27%
Nhc Advantage	$60 - $97	27%
Optima Health	$106	47%
Seven Corners, Inc.	$136 - $222	61%
First Health Coventry	$258 - $420	115%
Medcost	$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 Lee 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.