CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: PAM Rehabilitation Hospital of Clear Lake

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $67
Cash Discount Price: $89
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at PAM Rehabilitation Hospital of Clear Lake is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.30x the Medicare baseline. Located in 110 East Medical Center Boulevard, Webster, TX.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $89 (40%)

Insurance Median: $67 (30%)

Cash: $89 (40% of Medicare)

Ins. Median: $67 (30% 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	$9 - $10	4%
Wellpoint (Amerigroup)	$10	4%
Memorial Hermann Health Plan	$22	10%
Christus Health Plan	$36	16%
Scan Health Plan	$36	16%
Ninety Degree Benefits	$45	20%
Healthcare Highways	$49	22%
America'S Choice Provider Network	$62 - $134	28%
Provider Network Of America	$67 - $144	30%
Quik Trip	$67 - $144	30%
Usa Managed Care Organization	$67 - $144	30%
Velocity Provider Ppo Network	$67 - $144	30%
Multiplan/Phcs	$71 - $153	32%
Prime Health Services	$76 - $163	34%
Medincrease	$80 - $172	36%
UnitedHealthcare	$90	40%
Curative	$154	69%
Community Health Choice	$206	92%
Caresource	$216	97%

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 $89.
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 PAM Rehabilitation Hospital of Clear Lake 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.