Breathing treatment (nebulizer)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $213
- Cash Discount Price: $128
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Lucent Health [6000] | $175 | 78% |
| Blue Cross Blue Shield | $175 | 78% |
| Web Tpa [2115] | $175 | 78% |
| Oncology Patient Assistance Programs [2295] | $175 | 78% |
| Black Lung [6055] | $175 | 78% |
| Aetna | $175 | 78% |
| Healthcare Highways [2210] | $175 | 78% |
| Hooray Health [8000] | $175 | 78% |
| Department Of Corrections [1340] | $213 | 95% |
| National Association Of Letter Carriers [1695] | $246 | 110% |
| American Postal Workers Union [1070] | $246 | 110% |
| Healthpartners [1500] | $246 | 110% |
| Cigna | $246 | 110% |
| Humana | $251 | 112% |
| 1199 Seiu Benefit Fund [3505] | $287 | 128% |
| Enablecomp [1350] | $298 | 133% |
| Worker'S Comp [2125] | $298 | 133% |
| Multiplan [1680] | $331 | 148% |
| American Healthcare [1055] | $331 | 148% |
| Administrative Concepts [1005] | $331 | 148% |
| First Health [1375] | $331 | 148% |
| Coventry Healthcare [1320] | $349 | 156% |
| Ks Disability Determination [6090] | $426 | 190% |
Consumer Guidance & Cost Commentary
For this breathing treatment (nebulizer) service at the University Of Kansas Health System - St Francis Campus in Topeka, KS, the facility's cash price of $128.00 is significantly lower than the state average of $426.00 and the county average of $128.00. While the facility's negotiated rates with major payers like Aetna and Blue Cross Blue Shield average $175.00, these amounts are still higher than the cash price. For patients with high-deductible plans, paying the cash price of $128.00 upfront may result in substantial savings compared to the insurance negotiated rate, provided the patient's out-of-pocket costs do not exceed the cash amount. It is important to note that while the facility is a voluntary non-profit church-owned acute care hospital, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated rate by their insurance carrier.
The data indicates that the facility's cash price matches the county average exactly, but commercial insurance rates vary widely across different payers, ranging from $175.00 to $426.00 depending on the specific plan and payer. Because the facility's gross charge is $426.00, patients should be aware that balance billing could occur if they receive care from out-of-network providers or ancillary services not covered by their plan, though the No Surprises Act protects patients from such unexpected bills for emergency and non-emergency services at in-network facilities. To avoid errors, patients should demand a full itemized bill showing specific CPT codes rather than accepting a summary invoice,