CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Medical City North Hills

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $303
Cash Discount Price: $695
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Medical City North Hills is $303. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $695. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.35x the Medicare baseline. Located in 4401 Booth Calloway Road, North Richland Hills, TX.

Cash / Self-Pay

$695

Average discount available for prompt cash payment at this facility.

Insurance Median

$303

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: $695 (311%)

Insurance Median: $303 (135%)

Cash: $695 (311% of Medicare)

Ins. Median: $303 (135% 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
Superior Health Plan	$32 - $64	14%
Aetna	$62 - $663	28%
Cigna	$62 - $729	28%
Oscar	$96 - $190	43%
Unicare	$97 - $911	43%
United	$99 - $196	44%
Humana	$128	57%
Healthcare Highways	$156 - $308	70%
Blue Cross Blue Shield	$205 - $984	92%
City Of Mckinney	$208 - $410	93%
Fidelis Securecare	$208 - $410	93%
National Choicecare	$231 - $456	103%
Pc Texas Partners	$254 - $501	114%
Physicians Coop Of Tx	$254 - $501	114%
Rockport Health Group	$254 - $501	114%
Averde Health, Inc	$268 - $529	120%
Magellan Behavior Health	$277 - $547	124%
Coastal Comp Health Networks	$323 - $638	144%
Mega Life	$323 - $638	144%
Multiplan Phcs	$323 - $638	144%
Healthsmart Preferred Care	$346 - $684	155%
Lewisville Isd/Dls Consulting	$346 - $684	155%
Usa Managed Care	$369 - $729	165%
Usc Health Services	$369 - $729	165%
Galaxy Health Network	$393 - $775	176%
Independent Medical Systems	$462 - $911	207%
National Healthcare Solutions	$462 - $911	207%

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 $695.
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 Medical City North Hills 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.