Breathing treatment (nebulizer)
Facility: Salina Regional Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $112
- Cash Discount Price: $120
- vs. Medicare Baseline: 0.50x 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 |
|---|---|---|
| Preferred Phsic | $31 - $174 | 14% |
| Blue Cross Blue Shield | $40 - $46 | 18% |
| Preferred Healthcare - All Other Plans | $42 - $234 | 19% |
| Providers Care (Wppa)-All Plans | $47 - $260 | 21% |
| Aetna | $47 - $260 | 21% |
| Multiplan (Mpi)-All Plans | $47 - $260 | 21% |
| Cigna | $47 - $260 | 21% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Salina Regional Health Center in Salina, KS, lists a gross charge of $148.00. While the facility's cash median price is $120.00, commercial insurance negotiated rates vary significantly across payers, ranging from a low of $31.00 with Preferred Phsic to a high of $260.00 with Providers Care and Aetna. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics; therefore, patients with high-deductible plans may find paying the cash median of $120.00 more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible has not been met.
The facility's pricing aligns closely with state and county benchmarks, with a Medicare amount of $223.72 serving as the objective baseline for fair pricing. The facility's negotiated average of $112.00 is lower than the Medicare rate, suggesting competitive pricing relative to the federal standard. To ensure you receive the best possible rate, it is recommended to verify your specific plan's allowed amount before scheduling, as in-network rates can differ by payer. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can offer further reductions for upfront payment, and always request a detailed, itemized bill to review for any errors or unbundled charges before finalizing payment.