CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sweeny Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $82
Cash Discount Price: $70
vs. Medicare Baseline: 0.37x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sweeny Community Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.37x the Medicare baseline. Located in 305 North McKinney, Sweeny, TX.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $70 (31%)

Insurance Median: $82 (37%)

Cash: $70 (31% of Medicare)

Ins. Median: $82 (37% 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
Blue Cross Blue Shield	$29 - $164	13%
Evercare Mcaid	$48 - $164	21%
UnitedHealthcare	$52 - $263	23%
Aetna	$56 - $263	25%
Amerigroup Mcr Adv - All Other Plans	$56 - $191	25%
Community Hlth Choice Him - All Other Plans	$56 - $191	25%
Coventry Mcr Adv	$56 - $191	25%
Molina Mcr Adv - All Other Plans	$56 - $191	25%
Superior Hp Mcr Adv-All Other Plans	$56 - $191	25%
Wellcare Mcare - All Plans	$56 - $191	25%
Care Improvement Mcr - All Plans	$57 - $192	25%
Choicecare Mcr Adv - All Plans	$57 - $192	25%
Community Hlth Choice Star	$68 - $232	30%
Molina Mcaid	$68 - $232	30%
Superior Hp Mcaid	$68 - $232	30%
Tx Chlidrens Hp Mcaid - All Plans	$68 - $232	30%
Tx True Choice Mcaid - All Plans	$68 - $232	30%
Beech Street - All Plans	$73 - $246	33%
Community Care Network - All Plans	$77 - $263	34%
Galaxy Health Network - All Plans	$87 - $296	39%
Multiplan - All Plans	$87 - $296	39%
Evercare Mcr Adv - All Other Plans	$94 - $319	42%
Amerigroup Mcaid	$97 - $328	43%
Cigna	$120	54%

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 $70.
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 Sweeny Community 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.