CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Texas Orthopedic Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $66
Cash Discount Price: $146
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Texas Orthopedic Hospital is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.30x the Medicare baseline. Located in 7401 South Main Street, Houston, TX.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $146 (65%)

Insurance Median: $66 (30%)

Cash: $146 (65% of Medicare)

Ins. Median: $66 (30% 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	$9	4%
Community Health Choice Mcd	$19	8%
Amerigroup	$20	9%
Texas Childrens Health Plans	$24 - $35	11%
Oscar	$28	13%
United	$28 - $66	13%
Aetna	$30 - $50	13%
Texas Workforce Commission	$35	16%
Blue Cross Blue Shield	$51 - $596	23%
Christus (Usfhp)	$58	26%
Healthsmart Preferred Care	$63 - $124	28%
Averde Health	$66	30%
Fidelis Securecare Of Tx	$66	30%
Coventry National First Health	$78	35%
Physicians Cooperative Of Texas	$80	36%
Rockport Workers Comp	$80	36%
Independent Medical System	$88	39%
National Healthcare Solutions	$88	39%
Southwest Medical	$88	39%
Coastal Comp	$95	42%
Multiplan	$110 - $124	49%
International Health Insurance	$117	52%
Physicians, Inc	$124	55%
Affiliated Ppo	$131	59%
Humana	$174	78%
Texas Athletic Network	$300 - $600	134%

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 $146.
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 Texas Orthopedic 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.