CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Hillcrest Hospital Pryor

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $243
Cash Discount Price: $136
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hillcrest Hospital Pryor is $243. 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 1.09x the Medicare baseline. Located in 111 North Bailey Street, Pryor, OK.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$243

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: $243 (109%)

Cash: $136 (61% of Medicare)

Ins. Median: $243 (109% 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
Black Lung [6055]	$114	51%
Healthcare Highways [2210]	$114 - $295	51%
Hooray Health [8000]	$114	51%
Lucent Health [6000]	$114	51%
Oncology Patient Assistance Programs [2295]	$114	51%
Oscar Insurance Company [7005]	$114	51%
Osma Health Network [2345]	$114	51%
Healthscope Benefits [2290]	$139	62%
UnitedHealthcare	$139	62%
Aetna	$199	89%
Allied Benefit Systems Inc [1030]	$199	89%
Coresource [1315]	$199	89%
Coventry Healthcare [1320]	$199	89%
Meritain Health [1655]	$199	89%
The Kempton Group Administrators [2905]	$204	91%
Beacon Health Options Behavioral Health [2890]	$281	126%
Global Health [1430]	$281	126%
Resource One Administrators [2815]	$295	132%
Universal Fidelity [2085]	$295	132%
Web Tpa [2115]	$295	132%
First Health [1375]	$335	150%
Medica [2910]	$335	150%
Multiplan [1680]	$335	150%
Cigna	$374	167%
Healthpartners [1500]	$374	167%
Pba [1775]	$374	167%
Pending Ssi [1616]	$454	203%

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 Hillcrest Hospital Pryor 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.