CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Methodist Hospital Stone Oak

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $289
Cash Discount Price: $1,074
vs. Medicare Baseline: 1.29x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Methodist Hospital Stone Oak is $289. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,074. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.29x the Medicare baseline. Located in 1139 E Sonterra Blvd,, San Antonio, TX.

Cash / Self-Pay

$1,074

Average discount available for prompt cash payment at this facility.

Insurance Median

$289

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: $1,074 (480%)

Insurance Median: $289 (129%)

Cash: $1,074 (480% of Medicare)

Ins. Median: $289 (129% 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	$22 - $65	10%
Community First Health Plans	$53 - $350	24%
Amerigroup	$62 - $181	28%
Imperial Insurance	$85 - $246	38%
Oscar	$89 - $259	40%
United	$112 - $583	50%
Aetna	$118 - $648	53%
Cigna	$130 - $501	58%
Blue Cross Blue Shield	$131 - $1,256	59%
First Health	$196 - $571	88%
Fidelis Securecare	$200 - $583	89%
Tx Healthcare Foundation	$223 - $648	100%
Healthsmart Preferred Care	$245 - $713	110%
Independent Medical Systems	$245 - $713	110%
Haa Preferred Partners	$267 - $777	119%
San Antonio Employers Health Alliance	$267 - $777	119%
Coastal Comp Health Networks	$289 - $842	129%
National Healthcare Solutions	$289 - $842	129%
Multiplan	$334 - $1,101	149%
Triwest Health Alliance	$334 - $972	149%
Blue Bell	$356 - $1,036	159%
Directcare America	$356 - $1,036	159%
Managed Healthcare	$379 - $1,101	169%
National Choicecare	$537 - $648	240%
Texas Healthcare Foundation Heb	$537 - $648	240%
Physician Cooperative Of Texas	$591 - $713	264%
Tml Intergovernmental Ebp	$752 - $907	336%
Usa Managed Care	$805 - $972	360%

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 $1,074.
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 Methodist Hospital Stone Oak 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.