CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: The Outer Banks Hospital, Inc

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $181
Cash Discount Price: $158
vs. Medicare Baseline: 0.81x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at The Outer Banks Hospital, Inc is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.81x the Medicare baseline. Located in 4800 South Croatan Highway, Nags Head, NC.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $158 (71%)

Insurance Median: $181 (81%)

Cash: $158 (71% of Medicare)

Ins. Median: $181 (81% 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	$87 - $174	39%
Wellcare [1320]	$92 - $93	41%
Carolina Complete Health [1317]	$92 - $93	41%
Amerihealth McAid Adv [1316]	$93 - $94	42%
Liberty Advantage [1313]	$103 - $105	46%
UnitedHealthcare	$106 - $167	47%
Humana	$107 - $108	48%
Aetna	$109 - $222	49%
Longevity Health [1411]	$128 - $129	57%
Nc Dept of Public Safety [1095]	$177 - $179	79%
Medcost [1067]	$181 - $191	81%
Cigna	$239 - $270	107%
Multiplan [1031]	$267 - $270	119%

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 $158.
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 The Outer Banks Hospital, Inc 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.