CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Methodist McKinney Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $228
Cash Discount Price: $151
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Methodist McKinney Hospital is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.02x the Medicare baseline. Located in 8000 W Eldorado Pkwy Bldg C Suite C, McKinney, TX.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $151 (67%)

Insurance Median: $228 (102%)

Cash: $151 (67% of Medicare)

Ins. Median: $228 (102% 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
Aetna	$163 - $349	73%
Web Tpa [3049]	$172 - $193	77%
Champva [1000]	$196	88%
Tricare	$196	88%
Triwest Wps [8010]	$196	88%
Veterans Administration [9001]	$196	88%
Blue Cross Blue Shield	$215 - $578	96%
Medicare (plans)	$215 - $230	96%
UnitedHealthcare	$215 - $230	96%
Ust Health Proof [1005]	$215	96%
Wellcare [7016]	$215	96%
American Health Advantage Of Texas [7099]	$226	101%
Cigna	$226 - $228	101%
Globalhealth [1003]	$226	101%
Procare Advantage [7018]	$226	101%
Humana	$228	102%
Southwestern Health Resources Swhr [7015]	$228	102%
Provider Partners Health Plan [7025]	$232	104%
Alternative Service Concepts [8005]	$269	120%
Oscar Insurance Company [2057]	$280	125%
Bright Healthcare [2222]	$301	135%
Molina [3017]	$312	139%
Wellpoint Marketplace Exchange [3071]	$333	149%
90 Degree Benefit [3057]	$355	159%
Allied National [2031]	$355	159%
Entrust/90 Degree [2058]	$355	159%
Friday Health Plan [2061]	$366	164%
Ambetter / Centene	$368	164%
Imperial Insurance Companies [3073]	$387	173%
Evry Health [1013]	$430	192%
Sana Benefits [3069]	$430	192%
Velocity [3070]	$430	192%

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 $151.
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 McKinney 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.