CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Medical Center Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $113
Cash Discount Price: $117
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Medical Center Hospital is $113. 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 0.51x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

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: $113 (51%)

Cash: $117 (52% of Medicare)

Ins. Median: $113 (51% 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
Corvel Wc	$7 - $32	3%
Medicaid / KanCare	$23 - $35	10%
Superior Chips	$23 - $34	10%
UnitedHealthcare	$25 - $219	11%
Aetna	$58 - $462	26%
Caprock	$66 - $118	30%
Healthsmart Preferred Care	$66 - $148	30%
Blue Cross Blue Shield	$71 - $436	32%
Health Select	$71 - $338	32%
90 Degree Benefits	$79 - $118	35%
State Comptroller	$82 - $123	37%
Cigna	$83 - $218	37%
Texas Mutual Wc	$109 - $163	49%
Geha	$112 - $168	50%
Firstcare	$116 - $173	52%
Humana	$191	85%
Novitas Solutions	$216	97%
Triwest Va Ccn	$216	97%
Care Improvement Plus	$220	98%
Ambetter / Centene	$227	101%
Wellcare By Allwell	$227	101%
Group Resources	$264	118%
Workers Comp	$440	197%

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 Medical Center Hospital 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.