CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $285
Cash Discount Price: $301
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Baylor Scott & White Medical Center Pflugerville is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $301. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.27x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$301

Average discount available for prompt cash payment at this facility.

Insurance Median

$285

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: $301 (135%)

Insurance Median: $285 (127%)

Cash: $301 (135% of Medicare)

Ins. Median: $285 (127% 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	$90 - $191	40%
Baylor Scott & White Health Plan	$181 - $315	81%
Humana	$191 - $351	85%
Triwest	$191	85%
American Health Plan	$200	89%
Corvel	$200	89%
Healthspring	$200	89%
Prime Health Services	$200	89%
Procare Advantage	$200	89%
UnitedHealthcare	$219 - $347	98%
Cigna	$238 - $278	106%
Aetna	$276	123%
Midcoast	$276	123%
Quiktrip	$276	123%
Sedgwick	$285	127%
University Of Mary Hardin-Baylor	$291	130%
Independent Medical System	$301	135%
Curative	$326	146%
First Health	$351	157%
Healthsmart	$351 - $377	157%
Private Health Care System	$377	169%
Three Rivers	$452	202%
Blue Cross Blue Shield	$522 - $636	233%

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 $301.
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 Pflugerville 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.