CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Cox Medical Centers

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $67
Cash Discount Price: $117
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cox Medical Centers is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.30x the Medicare baseline. Located in 3801 South National Avenue, Springfield, MO.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $117 (52%)

Insurance Median: $67 (30%)

Cash: $117 (52% of Medicare)

Ins. Median: $67 (30% 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
Parkcrest Dental Group	$29	13%
Coastal Energy Corporation	$30	13%
Heart Of America Beverage Company	$30	13%
Loren Cook	$31	14%
Springfieldgreene Co Library	$31	14%
Ozark Anesthesia Assoc. Inc	$32	14%
Src Holdings Corporation	$32	14%
Justice Furniture And Bedding Co	$33	15%
Missouri Affiliated School Consortium (Masc)	$33	15%
Ozark County	$33	15%
The Durham Company	$33	15%
Advanced Concrete Technology	$34	15%
Flora Farms	$34	15%
Ozarks Cocacola	$34	15%
Texas Co Memorial Hospital	$62	28%
Bjc Health Solutions	$67 - $465	30%
UnitedHealthcare	$135 - $2,031	60%
Cox Healthplans	$218	97%
Health Net Federal Services	$218	97%
Humana	$218	97%
Medrisk Llc	$218	97%
Blue Cross Blue Shield	$222 - $1,549	99%
Allwell	$225	101%
Devoted	$234	105%
Provider Partners Health Plan	$234	105%

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 $117.
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 Cox Medical Centers 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.