CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Hillcrest Hospital Claremore

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $128
Cash Discount Price: $98
vs. Medicare Baseline: 0.57x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hillcrest Hospital Claremore is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.57x the Medicare baseline. Located in 1202 N Muskogee Place, Claremore, OK.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $98 (44%)

Insurance Median: $128 (57%)

Cash: $98 (44% of Medicare)

Ins. Median: $128 (57% 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]	$81	36%
Healthcare Highways [2210]	$81 - $128	36%
Hooray Health [8000]	$81	36%
Lucent Health [6000]	$81	36%
Oncology Patient Assistance Programs [2295]	$81	36%
Oscar Insurance Company [7005]	$81	36%
Osma Health Network [2345]	$81	36%
Healthscope Benefits [2290]	$98	44%
UnitedHealthcare	$98 - $128	44%
Resource One Administrators [2815]	$128	57%
Web Tpa [2115]	$128 - $143	57%
Beacon Health Options Behavioral Health [2890]	$140	63%
Aetna	$143	64%
The Kempton Group Administrators [2905]	$146	65%
Pba [1775]	$162	72%
Medica [2910]	$184	82%
Employee Benefit Management Services [2445]	$237	106%
Healthcost Solutions [2415]	$254	114%
Healthfirst [2395]	$254	114%
Hometown Health [2155]	$254	114%
Mayo Clinic Health Solutions [2280]	$254	114%
Planned Administrators Inc [2360]	$254	114%
Trustmark [2030]	$254	114%
Universal Fidelity [2085]	$254	114%

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 $98.
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 Claremore 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.