CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Texas Health Presbyterian Hospital Allen

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $301
Cash Discount Price: $311
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Texas Health Presbyterian Hospital Allen is $301. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $311. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.35x the Medicare baseline. Located in 1105 Central Expressway North, Allen, TX.

Cash / Self-Pay

$311

Average discount available for prompt cash payment at this facility.

Insurance Median

$301

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: $311 (139%)

Insurance Median: $301 (135%)

Cash: $311 (139% of Medicare)

Ins. Median: $301 (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
Amerigroup	$60 - $231	27%
Blue Cross Blue Shield	$60 - $1,511	27%
Parkland	$60	27%
UnitedHealthcare	$60 - $764	27%
Superior Wellcare	$63 - $242	28%
Molina	$64 - $231	29%
Aetna	$213 - $363	95%
American Health	$220	98%
Healthspring	$224	100%
Fort Worth Firefighters	$228 - $316	102%
Humana	$229	102%
City Of Fort Worth	$243	109%
Cigna	$286 - $487	128%
Quick Trip	$368	164%
Healthsmart	$388 - $435	173%
Phcs	$433	194%
Multiplan	$451	202%
Galaxy	$456	204%
Usa	$456	204%

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 $311.
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 Health Presbyterian Hospital Allen 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.