CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Matagorda Regional Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $190
Cash Discount Price: $112
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Matagorda Regional Medical Center is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.85x the Medicare baseline. Located in 104 7Th Street, Bay City, TX.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

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: $112 (50%)

Insurance Median: $190 (85%)

Cash: $112 (50% of Medicare)

Ins. Median: $190 (85% 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
Comm Care	$77 - $254	34%
Medicaid / KanCare	$77 - $254	34%
Molina	$77 - $254	34%
Scott & White	$77 - $254	34%
Superior	$77 - $254	34%
Tcstar	$77 - $254	34%
UnitedHealthcare	$77 - $313	34%
Wellpoint	$77 - $254	34%
Aetna	$86 - $284	38%
Humana	$89 - $294	40%
Coventry First Health	$96 - $317	43%
Galaxy Health	$96 - $317	43%
Cigna	$103 - $340	46%
Independent Medical System	$116 - $385	52%
Multiplan Phcs	$116 - $385	52%
Three Rivers	$116 - $385	52%
Health Smart	$123 - $408	55%
Usa Managed	$123 - $408	55%
Medicare (plans)	$202	90%
Triwest	$202	90%
United	$202	90%
Wellcare	$202	90%
Am Better	$242	108%
Alliance	$282	126%
Corvel	$403	180%
Blue Cross Blue Shield	$492 - $595	220%

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 $112.
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 Matagorda Regional Medical Center 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.