CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Womans Hospital of Texas,The

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $557
Cash Discount Price: $1,418
vs. Medicare Baseline: 2.49x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Womans Hospital of Texas,The is $557. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,418. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.49x the Medicare baseline. Located in 7600 Fannin, Houston, TX.

Cash / Self-Pay

$1,418

Average discount available for prompt cash payment at this facility.

Insurance Median

$557

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: $1,418 (634%)

Insurance Median: $557 (249%)

Cash: $1,418 (634% of Medicare)

Ins. Median: $557 (249% 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 249% of the Medicare baseline (a markup of 149%). 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
Superior Health Plan	$85	38%
Humana	$174	78%
Community Health Choice Mcd	$184	82%
Amerigroup	$199	89%
Oscar	$277	124%
Texas Athletic Network	$300 - $600	134%
Texas Childrens Health Plans	$336 - $370	150%
United	$345 - $638	154%
Aetna	$349 - $641	156%
Blue Cross Blue Shield	$430 - $719	192%
Christus (Usfhp)	$567	253%
Healthsmart Preferred Care	$610 - $1,205	273%
Averde Health	$638	285%
Fidelis Securecare Of Tx	$638	285%
Coventry National First Health	$756	338%
Physicians Cooperative Of Texas	$780	349%
Rockport Workers Comp	$780	349%
Independent Medical System	$851	380%
National Healthcare Solutions	$851	380%
Southwest Medical	$851	380%
Coastal Comp	$922	412%
Affiliated Ppo	$1,064	476%
Fiesta Mart, Inc	$1,064	476%
Multiplan	$1,064 - $1,205	476%
Physicians, Inc	$1,205	539%

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 $1,418.
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 Womans Hospital of Texas,The 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.