CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Stonewall Jackson Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $1,035
Cash Discount Price: $587
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Stonewall Jackson Memorial Hospital is $1,035. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $587. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 4.63x the Medicare baseline. Located in 230 Hospital Plaza, Weston, WV.

Cash / Self-Pay

$587

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,035

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: $587 (262%)

Insurance Median: $1,035 (463%)

Cash: $587 (262% of Medicare)

Ins. Median: $1,035 (463% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 463% of the Medicare baseline (a markup of 363%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$7 - $924	3%
Medicaid / KanCare	$7	3%
Aetna	$16 - $940	7%
Humana	$196	88%
Umwa	$196	88%
Ves	$196	88%
Universal_Health	$201	90%
Onenet	$1,014	453%
Healthsmart_Accel	$1,057	472%
Healthsmart_Auto	$1,057	472%
Healthsmart_Hpo	$1,057	472%
Healthsmart_Ppo	$1,057	472%
Sharpe	$1,057	472%
Cigna	$1,060	474%
UnitedHealthcare	$1,092	488%
Alliance_Ppo	$1,116	499%
Ccn	$1,116	499%
Multiplan	$1,116	499%
Napp	$1,145	512%
4_Most	$1,151	514%

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 $587.
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 Stonewall Jackson Memorial 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.