CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Methodist Midlothian Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $236
Cash Discount Price: $109
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Methodist Midlothian Medical Center is $236. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.05x the Medicare baseline. Located in 1201 E Highway 287, Midlothian, TX.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$236

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: $109 (49%)

Insurance Median: $236 (105%)

Cash: $109 (49% of Medicare)

Ins. Median: $236 (105% 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
UnitedHealthcare	$23 - $235	10%
Medicaid / KanCare	$101 - $220	45%
Aetna	$220 - $356	98%
Blue Cross Blue Shield	$220 - $233	98%
Covid19 Hrsa Uninsured Testing And Treatment Fund [6005]	$220	98%
Medicare (plans)	$220 - $235	98%
Ust Health Proof [1005]	$220	98%
Wellcare [7016]	$220	98%
American Health Advantage Of Texas [7099]	$231	103%
Cigna	$231 - $407	103%
Globalhealth [1003]	$231	103%
Procare Advantage [7018]	$231	103%
Humana	$233	104%
Southwestern Health Resources Swhr [7015]	$233	104%
Provider Partners Health Plan [7025]	$238	106%
Alternative Service Concepts [8005]	$275	123%
Oscar Insurance Company [2057]	$286	128%
Bright Healthcare [2222]	$308	138%
Molina [3017]	$319	143%
Wellpoint Marketplace Exchange [3071]	$341	152%
Kempton Group Administrators, Tower Extrusions [3061]	$352	157%
90 Degree Benefit [3057]	$363	162%
Allied National [2031]	$363	162%
Entrust/90 Degree [2058]	$363	162%
Friday Health Plan [2061]	$374	167%
Ambetter / Centene	$376	168%
Imperial Insurance Companies [3073]	$396	177%
Web Tpa [3049]	$407	182%
Department Of Labor [8004]	$440	197%
Evry Health [1013]	$440	197%
Generic Workers Comp Tx Non Par [9010]	$440	197%
Generic Workers Comp Tx Par [8002]	$440	197%
Generic Workers Comp Tx Par [9011]	$440	197%
Sana Benefits [3069]	$440	197%
Tristar Risk Management [8006]	$440	197%
Velocity [3070]	$440	197%
Health Plans Inc [5017]	$550	246%
Medical Cost Containment Professionals [3059]	$550	246%
Dart Member Care [3039]	$594	266%
Healthscope Benefits [2052]	$594	266%
Healthscope Benefits [3063]	$594	266%

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 $109.
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 Midlothian 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.