Breathing treatment (nebulizer)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $195
- Cash Discount Price: $159
- vs. Medicare Baseline: 0.87x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Humana | $7 - $194 | 3% |
| Medicaid / KanCare | $7 - $198 | 3% |
| Aetna | $7 - $207 | 3% |
| Blue Cross Blue Shield | $69 - $306 | 31% |
| Medica Contracted [320239] | $89 | 40% |
| United Medical Resources Contracted [320454] | $164 | 73% |
| UnitedHealthcare | $164 - $198 | 73% |
| Cigna | $168 - $188 | 75% |
| Elara Caring Aspire Hospice [20433] | $194 | 87% |
| Kindful Hospice [20434] | $194 | 87% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $194 | 87% |
| Halo Hcr Inc Hospice Contracted [320432] | $194 | 87% |
| Pace Of The Ozarks Contracted [320518] | $194 | 87% |
| Cross Timbers Hospice [20098] | $194 | 87% |
| Kindful Hospice Contracted [320434] | $194 | 87% |
| Tricare | $194 | 87% |
| Medicare (plans) | $194 - $202 | 87% |
| Dept Of Veteran Affairs Contracted [320106] | $194 | 87% |
| Mercy Hospice Okc [20252] | $194 | 87% |
| Halo Hcr Inc Hospice [20432] | $194 | 87% |
| Ebms Contracted [320493] | $195 | 87% |
| Mercy Benefit Admin Contracted [320251] | $195 | 87% |
| American Healthcare Alliance Contracted [320020] | $195 | 87% |
| Auxiant Contracted [320462] | $195 | 87% |
| Workers Comp [20426] | $195 | 87% |
| Reflect Health Contracted [320492] | $195 | 87% |
| Edison Health Solutions Contracted [320502] | $195 | 87% |
| Aither Health Contracted [320449] | $195 | 87% |
| Imagine 360 Contracted [320494] | $195 | 87% |
| Healthlink Contracted [320179] | $195 | 87% |
| Yuzu Health Contracted [320521] | $195 | 87% |
| Ambetter / Centene | $198 | 89% |
| Home State Health Plan Contracted [320187] | $198 | 89% |
| First Health Contracted [320128] | $207 | 93% |
| Providrs Care Network Contracted [320484] | $376 | 168% |
| Health Choice Contracted [320166] | $407 | 182% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Mercy Hospital Pittsburg, Inc. lists a gross charge of $244.00. While the facility's cash median rate is $159.00, which is lower than the Medicare benchmark of $223.72, commercial insurance negotiated rates vary significantly across the state of Kansas. The lowest negotiated rate found among 36 payers is $7.00, while the highest is $407.00. Notably, several major payers including Humana, Medicaid/KanCare, and Aetna have negotiated rates ranging from $7.00 to $207.00, whereas other contracted entities charge between $164.00 and $407.00. Patients with high-deductible plans may find the cash price of $159.00 more advantageous than the commercial negotiated rates for many insurers, as paying upfront can bypass administrative fees and potential balance billing scenarios.
To ensure you receive the most favorable pricing, it is critical to verify your specific plan's negotiated rate before scheduling, as in-network allowances can differ widely even within the same facility. If you are self-pay, you should explicitly request a prompt-pay discount, which typically offers a fee reduction of 20% to 50% for upfront payment, effectively lowering the cost below the standard cash median. Additionally, always demand a full itemized bill containing specific CPT codes rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled charges or services not rendered. By comparing the facility's