Breathing treatment (nebulizer)
Facility: Saint John Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $206
- Cash Discount Price: $206
- vs. Medicare Baseline: 0.92x 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 |
|---|---|---|
| Oha Networks | $31 | 14% |
| Worker Compensation | $32 | 14% |
| UnitedHealthcare | $69 - $220 | 31% |
| Medicaid / KanCare | $69 | 31% |
| Celtic | $70 - $220 | 31% |
| Healthy Blue | $70 - $217 | 31% |
| Blue Cross Blue Shield | $121 - $220 | 54% |
| Cigna | $206 | 92% |
| Aetna | $206 | 92% |
| Tricare | $206 | 92% |
| Medicare (plans) | $206 | 92% |
| Midland Care Connection | $206 | 92% |
| Kansas Superior Select | $210 | 94% |
| Centurion | $220 | 98% |
| Naphcare | $220 | 98% |
| Corizon | $220 | 98% |
| Employer Direct Healthcare | $220 | 98% |
| Well Path | $220 | 98% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Saint John Hospital in Leavenworth, KS, lists a gross charge of $220.00. The facility's cash median rate is $206.00, which is notably lower than the negotiated rates paid by most major payers. While many commercial insurers, including UnitedHealthcare, Celtic, and Healthy Blue, negotiate rates ranging from $69 to $220, the cash price remains the most affordable option for patients without insurance. This aligns with general billing principles where paying out-of-pocket can sometimes be cheaper than insurance reimbursement, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price.
Patients should be aware that while the facility's cash rate is competitive, the negotiated rates for in-network members vary significantly, with some payers like Cigna and Aetna paying the full $206.00, which matches the cash median. To minimize costs, individuals should contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill. Additionally, if a patient receives care from an out-of-network provider at this facility, they may be subject to balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act provides federal protections against such surprise bills for emergency and non-emergency services.