CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Charleston Area Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $134
Cash Discount Price: $136
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Charleston Area Medical Center is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.60x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $136 (61%)

Insurance Median: $134 (60%)

Cash: $136 (61% of Medicare)

Ins. Median: $134 (60% 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
Aetna	$12 - $149	5%
The Health Plan Of West Virginia Inc.	$12 - $156	5%
Unicare Health Plan Of West Virginia Inc.	$12	5%
Tricare	$80 - $89	36%
City Of Charleston	$100 - $112	45%
Blue Cross Blue Shield	$108 - $149	48%
Integrated Medical Solutions	$121 - $134	54%
Cigna	$125 - $139	56%
Three Rivers Providers Network	$130 - $145	58%
Triwest Va	$130 - $145	58%
Choicecare Network	$131 - $156	59%
Healthsmart	$131 - $146	59%
Multiplan	$131 - $146	59%
UnitedHealthcare	$131 - $153	59%
Caresource	$134 - $149	60%
Naphcare	$134 - $149	60%
Optimum Choice Inc.	$134 - $149	60%
West Virginia Senior Advantage Inc.	$141 - $156	63%

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 $136.
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 Charleston Area 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.