CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $225
Cash Discount Price: $225
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Baylor Scott & White Medical Center - Marble Falls is $225. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.01x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$225

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: $225 (101%)

Insurance Median: $225 (101%)

Cash: $225 (101% of Medicare)

Ins. Median: $225 (101% 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 Plan	$67 - $188	30%
Baylor Scott & White Health Plan	$136 - $310	61%
UnitedHealthcare	$185 - $216	83%
Humana	$188 - $262	84%
Triwest	$188	84%
Cigna	$193 - $226	86%
American Health Plan	$197	88%
Blue Cross Blue Shield	$197 - $636	88%
Corvel	$197	88%
Healthspring	$197	88%
Prime Health Services	$197	88%
Procare Advantage	$197	88%
Aetna	$206	92%
Midcoast	$206	92%
Quiktrip	$206	92%
University Of Mary Hardin-Baylor	$217	97%
Independent Medical System	$225	101%
Curative	$244	109%
First Health	$262	117%
Healthsmart	$262 - $281	117%
Bluebell Creameries	$281	126%
Private Health Care System	$281	126%
Sedgwick	$281	126%
Three Rivers	$337	151%

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 $225.
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 Baylor Scott & White Medical Center - Marble Falls 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.