CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Luke's Patients Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $336
Cash Discount Price: $209
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Luke's Patients Medical Center is $336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.50x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$336

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: $209 (93%)

Insurance Median: $336 (150%)

Cash: $209 (93% of Medicare)

Ins. Median: $336 (150% 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
Cigna	$100 - $417	45%
Blue Cross Blue Shield	$204 - $585	91%
Humana	$204	91%
Kelsey	$204	91%
Aetna	$208	93%
United	$208 - $1,604	93%
Amerivantage	$210	94%
Devoted	$218	97%
Scanhealth	$218	97%
Ambetter / Centene	$306	137%
Community Health Choice	$306	137%
Wellpoint	$306	137%
Bright Health	$314	140%
Coventry	$387	173%
First Health	$387	173%
Healthsmart	$417	186%
Multiplan	$447	200%

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 $209.
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 St Luke's Patients 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.