CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Hillcrest Hospital Henryetta

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $544
Cash Discount Price: $204
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Hillcrest Hospital Henryetta is $544. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $204. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.43x the Medicare baseline. Located in 2401 W Main, Henryetta, OK.

Cash / Self-Pay

$204

Average discount available for prompt cash payment at this facility.

Insurance Median

$544

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: $204 (91%)

Insurance Median: $544 (243%)

Cash: $204 (91% of Medicare)

Ins. Median: $544 (243% 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 243% of the Medicare baseline (a markup of 143%). 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
Black Lung [6055]	$170	76%
Lucent Health [6000]	$170	76%
Aetna	$299	134%
Coresource [1315]	$299	134%
Coventry Healthcare [1320]	$299	134%
Meritain Health [1655]	$299	134%
Cigna	$373	167%
Healthpartners [1500]	$373	167%
National Association Of Letter Carriers [1695]	$373	167%
Pba [1775]	$373	167%
Global Health [1430]	$422	189%
First Health [1375]	$461 - $585	206%
Multiplan [1680]	$461 - $585	206%
Healthcare Solutions [1485]	$483	216%
Community Care [1290]	$544	243%
Fmh Benefit Services [1390]	$544	243%
Group Resources [1455]	$544	243%
Phcs [1780]	$544 - $585	243%
Healthsmart [1505]	$578	258%
Administrative Concepts [1005]	$585	261%
Allied Benefit Systems Inc [1030]	$585	261%
Allied National Global Care [1035]	$585	261%
Gilsbar [1425]	$585	261%
Healthnet [1495]	$585	261%
New Era Life Insurance Company [1705]	$585	261%
Pan American Life Insurance Co [1770]	$585	261%
Trustmark [2030]	$585	261%
Pending Ssi [1616]	$680	304%

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 $204.
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 Henryetta 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.