Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC 94640 MDI/NEB INITIAL
San Antonio, TX
See all hospitals reporting CPT 94640 →Price type
Santa Rosa Hospital - Westover Hills’s median price of $194 is 7% below the median hospital's median price ($209), higher than 43% of the 2,511 hospitals reporting CPT 94640. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 payers, 35 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Aetna chip km percent of total billed charges · outpatientfrom % of charges | $67.82 | $65.08 | $40.37 – $89.10 |
| 2 | Aetna star km percent of total billed charges · outpatientfrom % of charges | $67.82 | $65.08 | $40.37 – $89.10 |
| 3 | Bcbs Tx star chip km percent of total billed charges · outpatientfrom % of charges | $67.82 | $65.08 | $40.37 – $89.10 |
| 4 | UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges | $110.97 | $106.50 | $66.06 – $145.80 |
| 5 | UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges | $110.97 | $106.50 | $66.06 – $145.80 |
| 6 | UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges | $110.97 | $106.50 | $66.06 – $145.80 |
| 7 | Molina chip km percent of total billed charges · outpatientfrom % of charges | $184.95 | $177.50 | $110.10 – $243.00 |
| 8 | Molina star plus km percent of total billed charges · outpatientfrom % of charges | $184.95 | $177.50 | $110.10 – $243.00 |
| 9 | Aetna mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 10 | Bcbs Tx mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 11 | Humana gold choice mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 12 | Humana gold plus mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 13 | Molina medicare adv mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 14 | UnitedHealthcare mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 15 | WellCare mm fee schedule · outpatient | $190.98 | $190.98 | $190.98 – $190.98 |
| 16 | Devoted mm fee schedule · outpatient | $206.26 | $206.26 | $206.26 – $206.26 |
| 17 | Humana choicecare per diem · outpatient | $208.00 | $208.00 | $208.00 – $208.00 |
| 18 | Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges | $277.43 | $266.25 | $165.15 – $364.50 |
| 19 | Cigna new business fee schedule · outpatient | $283.00 | $283.00 | $283.00 – $283.00 |
| 20 | First Health hmo percent of total billed charges · outpatientfrom % of charges | $314.42 | $301.75 | $187.17 – $413.10 |
| 21 | Aetna new business percent of total billed charges · outpatientfrom % of charges | $332.91 | $319.50 | $198.18 – $437.40 |
| 22 | Aetna epo percent of total billed charges · outpatientfrom % of charges | $369.90 | $355.00 | $220.20 – $486.00 |
| 23 | Aetna hmo percent of total billed charges · outpatientfrom % of charges | $369.90 | $355.00 | $220.20 – $486.00 |
| 24 | Aetna pos percent of total billed charges · outpatientfrom % of charges | $369.90 | $355.00 | $220.20 – $486.00 |
| 25 | Aetna ppo percent of total billed charges · outpatientfrom % of charges | $369.90 | $355.00 | $220.20 – $486.00 |
Last updated: Jan 13, 2026
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